Dallas, Texas residents seeking non 12 step treatment

Assisted Recovery has a proven history in treating individuals suffering from alcohol dependence who come to us from throughout the United States and beyond. We created the program in recognition of the difficulty in accessing a state-of-the-art evidence-based non-twelve step treatment program.   For years we have worked with clients from the greater Dallas area who are searching for non-twelve step, science based treatment.

Phoenix is a renowned resort destination with excellent airline service. The Accelerated two-week program is crafted to meet the needs of busy individuals living outside of the metropolitan Phoenix area. Phoenix or more accurately Surprise is the spring training home of the Texas Rangers.   Phoenix is now the home of many former Dallas residents.  While we recommend two weeks, the program can be completed in one week. The key to the success of this program is the utilization of effective medications, which within fifteen minutes of ingestion, often suppress the intense thought process or craving to drink alcohol. This levels the playing field, allowing the individual to be successful in a less restrictive environment.

Phoenix, Arizona  Assisted Recovery has been offering behavioral health services since 1997 and is a pioneer in the utilization of Medication Assisted Treatment (MAT) for alcohol and substance abuse.

We offer science based, empirically researched treatment.  Our protocols are based on the research and work of the University of Pennsylvania School of Medicine and, Dr. Joseph Volpiecilli, MD, PhD.  Dr. Volpiecilli was personally instrumental in the creation of the treatment protocols embraced by ARCA. Our website can be located at www.assistedrecovery.com.

Assisted Recovery offers a treatment program that has biological, psychological and social components. The medications (MAT) level the playing field dramatically, allowing an individual to focus on recovery and applying the cognitive behavioral therapy provided by ARCA.  The counseling staff also assists the individual address the social components of recovery, i.e. family, friends, work the general community.

The primary medications that we have extensive experience with for alcohol dependence include Naltrexone, Vivitrol®, Acamprosate (Campral ®) and Ondansetron. Once a patient has detoxed from opiates, we recommend Vivitrol®. Recently UCLA published a major study documenting the efficacy of naltrexone for the treatment of crystal methamphredine.   The medications are very benign in terms of side effects, and are not addicting in any way, emotionally or physically. They can be discontinued at any time without any adverse effect.

If you live in the Dallas area and have been looking for a science based treatment program that is non-12 step, contact Assisted Recovery today at 602-264-7897

Naltrexone Treatment for Columbus Area Residents

Assisted Recovery has a proven history in treating individuals suffering from alcohol dependence who come to us from throughout the United States and beyond. We created the program in recognition of the difficulty in accessing a state-of-the-art evidence-based non-twelve step treatment program.   For years we have worked with clients from the greater Columbus area who are searching for non-twelve step, science based treatment.

Phoenix is a renowned resort destination with excellent airline service. The Accelerated two-week program is crafted to meet the needs of busy individuals living outside of the metropolitan Phoenix area.   Phoenix is now the home of many former Columbus residents and with friendly people and a warm environment. While we recommend two weeks, the program can be completed in one week. The key to the success of this program is the utilization of effective medications, which within fifteen minutes of ingestion, often suppress the intense thought process or craving to drink alcohol. This levels the playing field, allowing the individual to be successful in a less restrictive environment.

Phoenix, Arizona  Assisted Recovery has been offering behavioral health services since 1997 and is a pioneer in the utilization of Medication Assisted Treatment (MAT) for alcohol and substance abuse.

We offer science based, empirically researched treatment.  Our protocols are based on the research and work of the University of Pennsylvania School of Medicine and, Dr. Joseph Volpiecilli, MD, PhD.  Dr. Volpiecilli was personally instrumental in the creation of the treatment protocols embraced by ARCA. Our website can be located at www.assistedrecovery.com.

Assisted Recovery offers a treatment program that has biological, psychological and social components. The medications (MAT) level the playing field dramatically, allowing an individual to focus on recovery and applying the cognitive behavioral therapy provided by ARCA.  The counseling staff also assists the individual address the social components of recovery, i.e. family, friends, work the general community.

The primary medications that we have extensive experience with for alcohol dependence include Naltrexone, Vivitrol®, Acamprosate (Campral ®) and Ondansetron. Once a patient has detoxed from opiates, we recommend Vivitrol®. Recently UCLA published a major study documenting the efficacy of naltrexone for the treatment of crystal methamphredine.   The medications are very benign in terms of side effects, and are not addicting in any way, emotionally or physically. They can be discontinued at any time without any adverse effect.

If you live in the Columbus area and have been looking for a science based treatment program that is non-12 step, contact Assisted Recovery today at 602-264-7897

 

 

Vivitrol & Naltrexone for Treating Opioid Dependence

Naltrexone is an opioid antagonist.  It blocks opioids from having any impact on the brain.  It eliminates the reward process of getting high. This makes naltrexone a vital tool for preventing relapse in people who have been detoxified from opioids.

Naltrexone is available in two forms: 1. Oral tablets and 2. An extended release injection.  The extended-release injectable form is known by the brand-name Vivitrol. The injection is administered by a physician or another medical provider once a month.

Injectable naltrexone is helpful for patients who find it difficult to stick with daily treatment. Especially since missing daily doses of those medications can sometimes lead patients to relapse.  While exactly the same medication, oral naltrexone is far less effective due to compliance issues.

“My patients say that every time they hold that tablet of oral naltrexone in their hand, they get a craving – they know if they don’t take it that day, they can get high,” says Herbert Kleber, MD, Professor of Psychiatry and Director of the Division on Substance Abuse at the Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute. “You don’t totally remove that feeling with extended release Naltrexone/Vivitrol, but at least you’re pushing it down the road for a month.”

 

Some Naltrexone/Vivitrol patients have stronger cravings after the third week, leading up to their next monthly injection. “It is very important, particularly during the first few months of treatment, that medication is administered on time or earlier,” explains Adam Bisaga, M.D., Research Scientist, New York State Psychiatric Institute and Professor of Psychiatry, Columbia University Medical Center. “Some doctors like to give it every three weeks during that time, while others may choose to add oral naltrexone during the fourth week for additional protection.”

Adherence to the medication schedule as prescribed by the doctor is very important, especially in the first few months of recovery.  The family and other support providers can play an important role in assuring that the patient is coming regularly for scheduled injections, or that they take an oral medication under a supervision if there is a delay in administering Vivitrol, to assure that the patient is well protected against relapse with a sufficient dose of medication.

Vivitrol is esscential  when the patient is completely past withdrawal, fully detoxified and highly motivated to stay in recovery and be protected against relapse. There should be no opioids in the body before starting Naltrexone/Vivitrol. Otherwise, withdrawal will be severe.

Naltrexone can have a few mild side effects. Almost always, the side effcts vanish after a few days.

Naltrexone/Vivitrol helps patients avoid relapse. It cannot be abused. It is not addicting in any way, emotionally or physically and may be discontinued at any time without adverse effects.

Vivitrol and naltrexone should always be an adjunct to counseling, for example cognitive behavior therapy.

 

Treatment for Chicago Area Residents

FOR CHICAGO AREA RESIDENTS

 

Assisted Recovery has a proven history in treating individuals suffering from alcohol dependence who come to us from throughout the United States and beyond. We created the program in recognition of the difficulty in accessing a state-of-the-art evidence-based non-twelve step treatment program.   For years we have worked with clients from the greater Chicago area who are searching for non-twelve step, science based treatment.

Phoenix is a renowned resort destination with excellent airline service. The Accelerated two-week program is crafted to meet the needs of busy individuals living outside of the metropolitan Phoenix area. Phoenix or more accurately Mesa is the spring training home of the world champions Chicago Cubs.   Phoenix is now the home of many former Chicago residents and boasts many famous Chicago based landmarks, for example Portillo’s. While we recommend two weeks, the program can be completed in one week. The key to the success of this program is the utilization of effective medications, which within fifteen minutes of ingestion, often suppress the intense thought process or craving to drink alcohol. This levels the playing field, allowing the individual to be successful in a less restrictive environment.

Phoenix, Arizona  Assisted Recovery has been offering behavioral health services since 1997 and is a pioneer in the utilization of Medication Assisted Treatment (MAT) for alcohol and substance abuse.

We offer science based, empirically researched treatment.  Our protocols are based on the research and work of the University of Pennsylvania School of Medicine and, Dr. Joseph Volpiecilli, MD, PhD.  Dr. Volpiecilli was personally instrumental in the creation of the treatment protocols embraced by ARCA. Our website can be located at www.assistedrecovery.com.

Assisted Recovery offers a treatment program that has biological, psychological and social components. The medications (MAT) level the playing field dramatically, allowing an individual to focus on recovery and applying the cognitive behavioral therapy provided by ARCA.  The counseling staff also assists the individual address the social components of recovery, i.e. family, friends, work the general community.

The primary medications that we have extensive experience with for alcohol dependence include Naltrexone, Vivitrol®, Acamprosate (Campral ®) and Ondansetron. Once a patient has detoxed from opiates, we recommend Vivitrol®. Recently UCLA published a major study documenting the efficacy of naltrexone for the treatment of crystal methamphredine.   The medications are very benign in terms of side effects, and are not addicting in any way, emotionally or physically. They can be discontinued at any time without any adverse effect.

If you live in the Chicago area and have been looking for a science based treatment program that is non-12 step, contact Assisted Recovery today at 602-264-7897

 

 

 

 

 

 

 

 

Marijuana May Alleviate America’s Opioid Crisis, New Study Suggests

In 2014, more than 14,000 people ― nearly 40 per day ― died from overdoses of prescribed opiates.

Access to medical marijuana may be cutting down on the overall use of opioids, including prescription painkillers like OxyContin and Percocet, new research suggests.

In a study, researchers from Columbia University’s Mailman School of Public Health analyzed traffic fatality data from 1999-2013 for 18 U.S states. They found that most states that passed medical marijuana laws saw an overall reduction in fatal crashes involving drivers who tested positive for opioids.

“We would expect the adverse consequences of opioid use to decrease over time in states where medical marijuana use is legal, as individuals substitute marijuana for opioids in the treatment of severe or chronic pain,” lead author June H. Kim, a doctoral student at Mailman, said in a statement.

The study, published Thursday in the American Journal of Public Health, is among the first to look at the link between state medical marijuana laws and opioid use. Medical marijuana laws, the authors concluded, are “associated with reductions in opioid positivity among 21- to 40-year-old fatally injured drivers and may reduce opioid use and overdose.”

marijuana

The United States is currently facing an epidemic of opioid painkiller abuse. Since 1999, opioid prescriptions and sales have quadrupled in the United States, a boom that the CDC said has “helped create and fuel” the current opioid abuse crisis. In 2014 alone, more than 14,000 people ― nearly 40 per day ― died from overdoses of prescribed opiates.

The Columbia study adds to a growing body of evidence showing cannabis can be an effective, alternative treatment for pain relief.

A 2014 study, for example, found that states with medical marijuana had fewer prescription painkiller overdose deaths than those without. And in July, researchers documented that states with medical marijuana saw a drop in prescription drugs,saving an estimated $165.2 million in Medicare costs.

In March, federal health officials issued new guidelines for opioid prescriptions in an effort to curb the crisis, urging doctors to largely avoid prescribing highly addictive painkillers like OxyContin and Vicodin when treating patients for chronic pain.

But the Drug Enforcement Administration has stopped short of embracing alternative painkillers, recently declining to loosen restrictions on marijuana and announcing plans to criminalize kratom, an herbal supplement that many say is effective at treating chronic pain and fighting opioid addiction.

At the state level, however, the tide is turning. Twenty-five U.S. states have legalized medical marijuana. Four of those, plus the District of Columbia, have also legalized recreational use of the substance.

“As states with these laws move toward legalizing marijuana more broadly for recreational purposes, future studies are needed to assess the impact these laws may have on opioid use,” Kim said in a statement.

The Surprising Failures of 12 Steps

How a pseudoscientific, religious organization birthed the most trusted method of addiction treatment

 

JAKE FLANAGIN for THE ATLANTIC

 

Say you’ve been diagnosed with a serious, life-altering illness or psychological condition. In lieu of medication, psychotherapy, or a combination thereof, your doctor prescribes nightly meetings with a group of similarly afflicted individuals, and a set of 12 non-medical guidelines for recovery, half of which require direct appeals to God. What would you do?

Especially to nontheists, the concept of “asking God to remove defects of character” can feel anachronistic. But it is the sixth step in the 12 Steps of Alcoholics Anonymous—the prototype of 12-step facilitation (TSF), the almost universally accepted standard for addiction-recovery in America today.

From its origins in the treatment of alcoholism, TSF is now applied to over 300 addictions and psychological disorders: drug-use, of course (Narcotics Anonymous), but also smoking, sex and pornography addictions, social anxiety, kleptomania, overeating, compulsive spending, problem-gambling, even “workaholism.”

Although AA does not keep membership records—the idea being pretty antithetical to the whole “anonymity” thing—the organization estimates that as of January 2013, more than 1 million Americans regularly attended meetings with one of roughly 60,000 groups. Dr. Lance Dodes, a recently retired professor of psychiatry at Harvard Medical School, estimates about 5 million individuals attend one or more meetings in a given year. Indeed the 12-step empire is vast, but Dodes thinks it’s an empire built on shaky foundations.

In his new book, released today, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry (co-written with Zachary Dodes), he casts a critical eye on 12-step hegemony; dissecting the history, philosophy, and ultimate efficacy of TSF, lending special scrutiny to its flagship program.

“Peer reviewed studies peg the success rate of AA somewhere between five and 10 percent,” writes Dodes. “About one of every 15 people who enter these programs is able to become and stay sober.”This contrasts with AA’s self-reported figures: A 2007 internal survey found that 33 percent of members said they had been sober for more than a decade. Twelve percent claimed sobriety for five to 10 years, 24 percent were sober for one to five years, and 31 percent were sober for under a year. Of course, those don’t take into account the large number of alcoholics who never make it through their first year of meetings, subsequently never completing the 12 steps (the definition of success, by AA’s standards).A report published by Alcoholism Treatment Quarterly in 2000 analyzed AA membership surveys taken from 1968 through 1996. On average, 81 percent of newcomers stopped attending meetings within the first month. After 90 days, only 10 percent remained. That figure was halved after a full year.Additionally, there’s AA’s barefaced religious affiliations to consider. True, the 12 steps have been worded in such a way as to suggest a certain amount of leeway in which God (or “higher power”) one ultimately surrenders to; but AA is a self-identified Christian organization with a significant portion of its methodology rooted in prayer. As it says in AA’s founding literature, known as the Big Book, “To some people we need not, and probably should not, emphasize the spiritual feature on our first approach. We might prejudice them. At the moment we are trying to put our lives in order. But this is not an end in itself. Our real purpose is to fit ourselves to be of maximum service to God.”So how did AA gain such a place of privilege in American health-culture? How did a regimen so overtly religious in nature, with a 31 percent success rate at best, a five to 10 percent success rate at worst, and a five percent overall retention rate become the most trusted method of addiction-treatment in the country, and arguably the world? It’s a central question Dodes seeks to answer in The Sober Truth. And he begins at the very beginning.
According to Dodes, when the Big Book was first published in 1939, it was met with wide skepticism in the medical community. The AMA called it “a curious combination of organizing propaganda and religious exhortation.  The AMA further wrote ”For many pears the public was beguiled into believing that short courses of enforced abstinence and catharsis in “institutes” and “rest homes” would do the trick, and now that the failure of such temporizing has become common knowledge, a considerable number of other forms of quack treatment have sprung up.”  A year later, the Journal of Nervous and Mental Diseases described it as “a rambling sort of camp-meeting confession of experiences … Of the inner meaning of alcoholism there is hardly a word. It is all surface material.”That perception has since radically changed, albeit gradually, thanks in no small part to the concerted efforts of AA’s early pioneers. They “realized early on that to establish true legitimacy, they would eventually need to earn the imprimatur of the scientific community,” writes Dodes. Which they did, with aplomb, largely by manufacturing an establishment for addiction scholarship and advocacy that did not previously exist. They created a space for AA to dictate the conversation.
The National Council on Alcoholism and Drug Dependence, one of the foremost American advocacy-agencies for recovering addicts, was founded in 1944 by Marty Mann—a wealthy and well-connected Chicago debutante, and the first female member of AA. The Center of Alcohol Studies at Rutgers University, an international leader in alcoholism-related research, was founded at Yale in 1943 under the direction of E. Morton Jellinek. Jellinek, the author of several seminal texts on alcoholism and an eventual WHO consultant on the condition, placed AA-founder and Big Book author Bill Wilson on the faculty—a man who claimed to have been cured of his own alcoholism not through the progress of scientific research, but by divine intervention.In 1951, based on what Dodes calls “the strength of self-reported success and popular articles” (The Saturday Evening Post was a major supporter), AA received a Lasker Award, which is “given by the American Public Health Association for outstanding achievement in medical research or public health administration.” This despite “no mention of any scientific study that might prove or disprove the organization’s efficacy,” writes Dodes. But it was nevertheless a marked moment AA’s history; the moment it entered the medical establishment, and by proxy, gained implicit trust from the American public on matters of alcohol abuse.Two decades later, in 1970, Congress passed a landmark bill called the “Comprehensive Alcohol Abuse and Alcoholism Prevention Treatment and Rehabilitation Act,” precipitating the establishment of the National Institute on Alcohol Abuse and Alcoholism, part of the U.S. National Institutes of Health. “Among those testifying to the lawmakers in support of the bill,” writes Dodes, “were Marty Mann and Bill Wilson.”

 

In 1989, America’s first drug court began sentencing “nonviolent drug offenders” to 12-step programs. Although court-mandated participation in 12-step programs would eventually be deemed unconstitutional (thanks to items like Step Six), Dodes claims “judges still refer people to AA as a part of sentencing or a condition of probation.”

This brings us to the present: an addiction-treatment landscape envisioned and engineered almost entirely by AA. TSF is the law of the land. If you have a drinking problem in 2014, or a drug problem, or a gambling problem, your medically, socially, culturally, and politically mandated solution is a set of 12 steps. The only other options, as asserted by the Big Book, are “jails, institutions, and death.”And any suggestion that AA might be a flawed program, or not right for every addict, is met with scandalized looks and harsh retorts. AA, simply put, is pretty popular among the non-addicted. “In the absence of sophisticated knowledge,” writes Dodes, “platitudes and homilies rush in to fill the void, many of which obscure far more than they illuminate. Folklore and anecdote are elevated to equal standing with data and evidence. Everyone’s an expert, because everyone knows somebody who has been through it. And nothing in this world travels faster than a pithy turn of phrase.”But society at large is guilty of more than just perpetuating the dominion of AA and TSF with “folklore and anecdote.” We are just as guilty of driving addicts into the program as the program is of raising the specter of a sole avenue to recovery.Despite the popular glorification of TSF, addiction remains an oft-trivialized topic, and the addict an oft-ridiculed figure. A night of heavy drinking might be punctuated with an off-the-cuff comment like, “I am such an alcoholic!” Or incredulity expressed through hyperbolic questions like, “Are you on crack?” The meth-addict, as portrayed on TV shows like Breaking Bad and Inside Amy Schumer, is the commonly accepted lowest form of human-scum, deserving of not just ridicule, but violent death. The addict is disposable. Or a recyclable punchline.When, as a culture, we ascribe the addict the lowest possible social value, is it any wonder why they flock to a fellowship of equally alienated individuals with common lived-experiences? Organizations like AA? It’s true addicts are deserving of treatment plans based in something more than blind faith—Dodes’s argument is more than persuasive in that regard—but pills and therapy and data and evidence aren’t necessarily enough to treat a condition so inherently linked to emotional wellbeing and self-worth. The addict, like any human, craves community. And if the greater community persists in shunning and shaming addicts, and AA remains the only door left ajar, then it’s to AA the addicts will go. And who could blame them?

Just one alcoholic drink a day increases risk of breast cancer, study says

Just one glass of wine or other alcoholic drink a day significantly raises the risk of breast cancer, while vigorous exercise such as running and bicycling reduces it, according to an expansive review of research on the effects of diet, nutrition and physical activity on the disease.

The report, which was issued Tuesday, concluded that drinking the equivalent of one small glass of wine, beer or other alcohol a day — about 10 grams of alcohol — is linked to an increased cancer risk of 5 percent for pre-menopausal women and 9 percent for post-menopausal women. A standard drink has 14 grams of alcohol.

“This suggests there is no level of alcohol use that is completely safe in terms of breast cancer,” said Anne McTiernan, a cancer-prevention researcher at Fred Hutchinson Cancer Research Center in Seattle and one of the report’s lead authors. “If a woman is drinking, it would be better if she kept it to a lower amount.”

The review, by the American Institute for Cancer Research (AICR) and the World Cancer Research Fund, evaluated research in 119 studies encompassing data on 12 million women from around the world. It is the first such review since 2010, the groups said.

For the first time, researchers concluded evidence is strong that vigorous exercise reduces breast-cancer risk. Pre-menopausal women who were the most active had a 17 percent lower risk of developing malignancies compared to the least active women, while post-menopausal women had a 10 percent decreased risk.

The researchers noted that many things influence cancer risk and that women can’t control factors such as a family history of cancer. But, McTiernan said, “having a physically active lifestyle, maintaining a healthy weight throughout life and limiting alcohol — these are all steps women can take to lower their risk.”

At the same time, she said, a healthy lifestyle is not a guarantee. Rather, it’s more like wearing a seat belt. Many women will do everything they can to reduce their risks of breast cancer but still get diagnosed. “That’s unfortunate, but that’s what happens,” she said.

Researchers were not able to calculate the degree to which vigorous exercise might cut the risk of alcohol consumption. What happens, for example, if a regular drinker also runs daily?

“The mechanism suggests that it could be helpful,” McTiernan said. Alcohol increases estrogen, which is linked to increased breast-cancer risk, while physical activity reduces it. “But I can’t say that for someone who drinks five drinks and then runs, that the exercise is going to negate the adverse effects of the alcohol.”

The report found women who are overweight or obese have a higher risk of post-menopausal disease.

“If women lose just 10 percent of their weight, it’s linked to reduced blood estrogen, inflammation” and other factors associated with breast cancer, McTiernan said.

The report also found limited evidence linking dairy foods, diets high in calcium and foods containing carotenoids to a lower risk of some breast cancers. Carotenoids include such fruits and vegetables as kale, apricots and carrots.

About 252,000 women in the United States are expected to be diagnosed with breast cancer this year. AICR estimates that 1 in 3 cases could be prevented if women did not drink alcohol, were physically active and maintained a healthy weight.

Ondansetron & Opiate Treatment

Scientists at the School of Medicine have discovered that a commonly available non-addictive drug can prevent symptoms of withdrawal from opioids with little likelihood of serious side effects. The drug, ondansetron, which is already approved to treat nausea and vomiting, appears to avoid some of the problems that accompany existing treatments for addiction to these powerful painkillers, the scientists said.

Opioids encompass a diverse array of prescription and illegal drugs, including codeine, morphine and heroin. In 2007, about 12.5 million Americans aged 12 and older used prescription pain medications for non-medical purposes, according to the National Survey on Drug Use and Health, administered by the federal government’s Substance Abuse and Mental Health Services Administration.

“Opioid abuse is rising at a faster rate than any other type of illicit drug use, yet only about a quarter of those dependent on opioids seek treatment,” said Larry Chu, MD, assistant professor of anesthesia and lead author of the study that was published online Feb. 17 in the Journal of Pharmacogenetics and Genomics. “One barrier to treatment is that when you abruptly stop taking the drugs, there is a constellation of symptoms associated with withdrawal.” Chu described opioid withdrawal as a “bad flu,” characterized by agitation, insomnia, diarrhea, nausea and vomiting.

Current methods of treatment are not completely effective, according to Chu. One drug used for withdrawal, clonidine, requires close medical supervision as it can cause severe side effects, while two others, methadone and buprenorphine, don’t provide a satisfactory solution because they act through the same mechanism as the abused drugs. “It’s like replacing one drug with another,” said co-investigator Gary Peltz, MD, PhD, professor of anesthesia.

“What we need is a magic bullet,” said Chu. “Something that treats the symptoms of withdrawal, does not lead to addiction and can be taken at home.”

The researchers’ investigation led them to the drug ondansetron, after they determined that it would block certain receptors involved in withdrawal symptoms.

The scientists were able to make this connection thanks to their having a good animal model for opioid dependence. Mice given morphine for several days develop the mouse equivalent of addiction. Researchers then stop providing morphine to trigger withdrawal symptoms. Strikingly, these mice, when placed into a plastic cylinder, will start to jump into the air. One can measure how dependent these mice are by counting how many times they jump. Like humans, dependent mice also become very sensitive to pain when they stop receiving morphine.

But the responses vary among the laboratory animals. There are “different flavors of mice,” explained Peltz. “Some strains of mice are more likely to become dependent on opioids.” By comparing the withdrawal symptoms and genomes of these different strains, it’s possible to figure out which genes play a major role in addiction.

To accomplish this feat, Peltz and his colleagues used a powerful computational “haplotype-based” genetic mapping method that he had recently developed, which can sample a large portion of the genome within just a few hours. This method pinpoints genes responsible for the variation in withdrawal symptoms across these strains of mice.

The analysis revealed an unambiguous result: One particular gene determined the severity of withdrawal. That gene codes for the 5-HT3 receptor, a protein that responds to the brain-signaling chemical serotonin.

To confirm these results, the researchers injected the dependent mice with ondansetron, a drug that specifically blocks 5-HT3 receptors. The drug significantly reduced the jumping behavior of mice as well as pain sensitivity—two signs of addiction.

The scientists were able to jump from “from mouse to man” by sheer luck: It turns out that ondansetron is already on the market for the treatment of pain and nausea. As a result, they were able to immediately use this drug, approved by the Food and Drug Administration, in eight healthy, non-opioid-dependent humans. In one session, they received only a single large dose of morphine, and in another session that was separated by at least week, they took ondansetron in combination with morphine. They were then given questionnaires to assess their withdrawal symptoms.

Similar to mice, humans treated with ondansetron before or while receiving morphine showed a significant reduction in withdrawal signs compared when they received morphine but not ondansetron. “A major accomplishment of this study was to take lab findings and translate them to humans,” said principal investigator J. David Clark, MD, PhD, professor of anesthesia at the School of Medicine and the Palo Alto Veterans Affairs Health Care System.

Chu plans on conducting a clinical study to confirm the effectiveness of another ondansetron-like drug in treating opioid withdrawal symptoms in a larger group of healthy humans. And the research team will continue to test the effectiveness of ondansetron in treating opioid addiction.

The scientists warned that ondansetron will not by itself resolve the problems that arise with continued use of these painkillers. Addiction is a long-term, complex process, involving both physical and psychological factors that lead to compulsive drug use. “This is not a cure for addiction,” said Clark. “It’s naïve to think that any one receptor is a panacea for treatment. Treating the withdrawal component is only one way of alleviating the suffering. With luck and determination, we can identify additional targets and put together a comprehensive treatment program.”

Collaborators on this study included De-Yong Liang, PhD, the study’s co-lead author, previously a research associate in the Department of Anesthesia and currently a research associate at the Palo Alto Institute for Research and Education; Xiangqi Li, MD, a life science research assistant in the department; Nicole D’Arcy, a medical student; Peyman Sahbaie, MD, a research associate at the institute; and Guochun Liao, PhD, of the pharmaceutical company Hoffman-La Roche. This work was supported by grants to Clark from the National Institutes of Health and the National Institute on Drug Abuse, and grants to Chu from the NIH and the National Institute of General Medical Sciences.

The researchers are working with the Stanford University Office of Technology Licensing to seek a patent for the use of ondansetron and related medicines in the treatment of drug addiction.

Opiate Dependence & Medication Assisted Treatment (MAT)

“I wish that all families would at least consider investigating medication-assisted treatment and reading about what’s out there,” says Alicia Murray, DO, Board Certified Addiction Psychiatrist. “I think, unfortunately, there is still stigma about medications. But what we want people to see is that we’re actually changing the functioning of the patient.”

Essentially, medication-assisted treatment (MAT) can help get a patient back on track to meeting the demands of life – getting into a healthy routine, showing up for work and being the sibling, spouse or parent that they once were. “If we can change that with medication-assisted treatment and with counseling,” says Murray, “that’s so valuable.”

The opioid epidemic is terrifying, especially so for the family of someone already struggling with prescription pills or heroin use. It’s so important to consider any and all options for helping your child recover from their opioid dependence.

Part of the reason it’s so hard to overcome an opioid addiction is because it rewires your brain to focus almost exclusively on the drug over anything else, and produces extreme cravings and withdrawal symptoms as a result. By helping to reduce those feelings of cravings and withdrawal, medication-assisted treatment can help the brain to stop thinking constantly about the drug and focus on returning to a healthier life.

Medication-assisted treatment is often misunderstood. Many traditional treatment programs and step-based supports may tell you that MAT is simply substituting one addictive drug for another. However, taking medication for opioid addiction is like taking medication for any other chronic disease, such as diabetes or asthma. When it is used according to the doctor’s instructions and in conjunction with therapy, the medication will not create a new addiction, and can help.

“MAT medications are most effective when they are used in conjunction with therapy and recovery work. We would never recommend medication over other forms of treatment. We would recommend it in addition to it.”

Common medications used to treat opioid addiction are:

  • Naltrexone (Vivitrol)
  • Buprenorphine (Suboxone)
  • Ondansetron

NALTREXONE / VIVITROL
Naltrexone, known by its brand-name Vivitrol, is administered by a doctor monthly through an injection. Naltrexone is an opioid antagonist. Antagonists attach themselves to opioid receptors in the brain and prevent other opioids such as heroin or painkillers from exerting the effects of the drug. It has no abuse potential. Vivitrol is an injectable form of naltrexone and is effective for 30 days. Even if a person wants to use, if they have naltrexone or Vivitrol in their system, they cannot. It is a form of insurance against relaspe that is vital to treatment.

BUPRENORPHINE (SUBOXONE)
Buprenorphine, known by its brand-name Suboxone, is an oral tablet or film dissolved under the tongue or in the mouth prescribed by a doctor in an office-based setting. It is taken daily and can be dispensed at a physician’s office or taken at home. Buprenorphine is a partial agonist. Partial agonists attach to the opioid receptors in the brain and activate them, but not to the full degree as agonists. If used against the doctor’s instructions, it has the potential to be abused.

ONDANSETRON
Scientists at the Stanford School of Medicine have discovered that a commonly available non-addictive drug can prevent symptoms of withdrawal from opioids with little likelihood of serious side effects. The drug, ondansetron, which is already approved to treat nausea and vomiting, appears to avoid some of the problems that accompany existing treatments for addiction to these powerful painkillers, the scientists said.

 

There is no “one size fits all” approach to medication-assisted treatment, or even recovery. Recovery is individual. The most important thing to do is to consider all of your options.

Harm Reduction and Medical Marijuana

(CNN)Harm reduction is a strategy for treating addiction that begins with acceptance. A friendlier, less disciplined sister of abstinence, this philosophy aims to reduce the overall level of drug use among people who are unable or simply unwilling to stop. What should naturally follow is a decrease in the many negative consequences of drug use.

In other words: progress, not perfection, as advocates of Alcoholics Anonymous often say.
Most European countries and Canada have embraced the idea of harm reduction, designing policies that help people with drug problems to live better, healthier lives rather than to punish them.
On the front lines of addiction in the United States, some addiction specialists have also begun to work toward this end.
Joe Schrank, program director and founder of High Sobriety, is one of them. He says his Los Angeles-based treatment center uses medicinal cannabis as a detox and maintenance protocol for people who have more severe addictions, although it’s effectiveness is not scientifically proven.
“So it’s a harm-reduction theory,” he said. “With cannabis, there is no known lethal dose; it can be helpful for certain conditions.”
“Some say it’s hypocritical because, you know, you’re supposed to go to rehab to get off drugs,” said Schrank, who recently celebrated 20 years of sobriety from alcohol and all drugs. “And cessation of drug use can be a goal for some people, but pacing is also important.” Some patients want to gradually move into abstinence, weaning themselves off drugs over time. Others want to maintain sobriety from a drug by using a less harsh drug, such as cannabis.
 Others, including Todd Stumbo, CEO of Blue Ridge Mountain Recovery Center in Georgia, do not favor using marijuana as treatment for addiction.
“I’m all about adding interventions and therapeutic techniques that have proven to be significantly profound in the changes to somebody’s life and treatment. Unfortunately, I don’t know that there’s evidence to substantiate that marijuana’s had that effect,” says Stumbo. “Our take is abstinence based and we use every tool or intervention we can that’s been proven effective in the past.”
Still, harm reduction is gaining acceptance in the wider field of addiction specialists in the U.S.
“In principle, what we have aimed for many years is to find interventions that would lead to complete abstinence,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse. Practically, though, that has been very difficult to achieve with relapsing addictions.
“One of the things is, we don’t have any evidence-based medication that has proven to be efficacious for the treatment of cocaine addiction,” Volkow said. “So we currently have no medicine to intervene, and it can be a very severe addiction and actually quite dangerous.”
Dangerous because it gives users a high that literally alters the brain. Medical consequences of cocaine addiction include seizure, stroke and bleeding within the brain.
“We have started to explore the extent to which interventions that can decrease the amount of drug consumed can have benefits to the individual,” Volkow said, adding that she’d make this same argument for opioids and heroin. “It would be valuable to decrease the amount of drug consumed.”
Schrank is clear on the value of simply reducing drug use.
“We think of addiction as this light switch you can turn on and off,” he said. “What we’re learning is that for some people, it’s similar to scuba diving: You can only come up 20 feet so often or you get very, very sick. When people stop immediately and that abruptly, it really makes them vulnerable.”
Schrank, who readily concedes there are possible health and addiction risks with marijuana, says he offers his cannabis detox and maintenance protocol to people addicted to crack cocaine as well as those trying to kick opioids. Through the years, he says, he’s treated about 50 people with this technique and expects to see “more people wanting to try to have a voice in their recovery rather than just plug into systems telling them what to do.”
Marijuana “can really help people with pain management and other health issues, or it can help them be safer,” Schrank said.
Reversing heroin’s damage

Yasmin Hurd, director of the Addiction Institute at Mount Sinai School of Medicine, says generally, cannabidiol is the more important compound when it comes to marijuana as a treatment for addiction. It is one of the two primary cannabinoids, along with Δ9-tetrahydrocannabinol (THC), found in the cannabis plant. In terms of the wider scope of medical marijuana research, this is the “same cannabidiol being looked at for the kids with epilepsy,” Hurd said.

THC, she says, binds to cannabinoid receptors in our brains (as do the natural cannabinoids our bodies produce), and it is the stimulation of those receptors that brings a “high.” By comparison, cannabidiol has very weak effects in this regard and negatively modulates that receptor, instead.
Yet cannabidiol reverses some of the brain changes that occur with heroin use, Hurd says, based on her own studies of the compound.
 For instance, heroin harms the glutamate transmitter system, which is important for decision-making, cognition and even reward, explains Hurd.
“We found that (cannabidiol) reversed the impairments caused by heroin, for example, on the glutamatergic receptors,” Hurd said. Similarly, cannabidiol reversed damage to the cannabinoid receptors themselves caused by heroin, while activating the serotonin system: the neurotransmitter system believed to affect mood and a common target for makers of anti-anxiety and antidepressant medications.
More generally, cannabidiol positively influences our biological systems that are linked to the negative components of addiction, such as anxiety and inhibitory control, Hurd suggests.
“We still haven’t figured out how it works,” Hurd said. She notes that although cannabidiol is believed to be a “treatment to consider for opioid addiction and other drugs,” there aren’t a lot of data, especially with regard to its potential effects for cocaine addiction.
Adding to the data is a recent study, funded in part by a company applying to the Canadian government for a license to produce medical cannabis, exploring one possible harm reduction plan: swapping crack cocaine for marijuana.
Studying crack users

Crack cocaine is said to be a low-end incarnation of a rich man’s drug. Cocaine, an expensive stimulant made from the leaves of the coca plant native to South America, can be processed to make a cheap crystal rock or “crack.” The name refers to the crackling sound the rock makes when heated so its vapors can be inhaled through a pipe, but many users prefer to mix crack with vinegar to form a liquid that can be injected. This form becomes much higher-risk to users who are likely to share needles.

To explore whether smoking marijuana might reduce crack use, researchers led by M-J Milloy, an infectious disease epidemiologist and research scientist at the BC Centre for Excellence in HIV/AIDS, recruited drug users living within the greater Vancouver area of British Columbia.
Milloy and his colleagues measured and analyzed how frequently 124 drug users smoked or injected crack before, during and after a period of cannabis use, based on their own self-reports.
Crack use did not decrease during the period when participants intentionally self-medicated with cannabis, compared with the time before trying marijuana
.
Afterward, crack use decreased significantly, with participants reporting using it on average about half as often as before the intervention.
“We certainly have no illusions that this is the final word on the matter. Indeed, I think what it really is, it may be a first step,” Milloy said of his study, which was recently published in the journal Addictive Behaviors. “So what we hope is that further study will let us know if it is in fact an effective substitution treatment for crack cocaine use disorder. To that end, we are putting together a clinical trial, which we hope will better test the hypothesis that cannabis could be useful to people who are suffering from this disorder.”
Although the Vancouver study did not investigate the brain science to explain how marijuana might have this effect, Milloy and his co-authors say that emerging data “provide biological plausibility” for the findings.
They reference animal studies demonstrating that THC and cannabidiol may help eliminate cocaine-craving and heroin-seeking behaviors. One study in rodents showed cannabidiol to disrupt the reconsolidation of cocaine- and opioid-related memory, while findings from human trials suggest that high doses of cannabidiol effectively decreased cravings and anxiety among heroin-dependent people.
Volkow believes the Vancouver study result, showing that smoking marijuana reduced use of cocaine (though without producing abstinence), is an “interesting finding that cannot be ignored.”

‘Be yelled at for 30 days’

Generally, she says, not a lot of study has been done in the area of swapping cannabis for cocaine, and she emphasizes the need to determine whether the result can be replicated and studied even more extensively “under a clinical trial-type design, so you can actually document that cannabinoids can decrease consumption of cocaine.”
“There have been a couple of papers that have reported actually some beneficial effects of marijuana smoking and the use of other drugs, but there also was one other paper that reported the opposite,” Volkow said.
That paper found, “an increase instead of a reduction in the severity of cocaine withdrawal symptoms,” and concluded, “worse detoxification treatment response.”
To remedy the lack of scientific evidence, the National Institute of Drug Abuse is funding projects investigating synthetic THC for treatment of substance use disorder and providing grants for other projects testing cannabidiol for the treatment of methamphetamine use disorder and relapse prevention. The institute is also looking at the endocannabinoid system as a potential therapy for alcohol use disorder and opioid withdrawal.
“The paradigm as it is now is, wait until it’s a crisis and then be yelled at for 30 days, and then you’re never supposed to do it again,” Schrank said.
Abstinence is “a hard thing for people to do, and I don’t know that we give people enough space to grow and develop,” he said. “Most people coming off crack or heroin would want the insulation of some kind of feeling change.”
Although most people in the treatment world would say an addicted client who swapped harder drugs for pot has a relapse and not recovery, Schrank said, “to me, if somebody was using heroin and now they’re using cannabis, that’s a major victory.”
“If you smoke the wrong rock of crack, your heart stops,” he said. “It’s very, very, very dangerous.”
“I’ve had so many clients who were in treatment and seemingly doing well, and then they dropped dead,” Schrank said. “If rehab worked so well, why is the success rate like 5%? We’re definitely doing something wrong.”