Archive for October, 2007

The Next Best Thing …

Friday, October 19th, 2007

The Next Best Thing to Winning for a Compulsive Gambler is Losing

The feeling I was looking for was the terror . . . that absolute sinking feeling after I hadn’t beat the spread in a football game or I had used money I couldn’t lose (like my rent). That was even better than hitting 2 races in an afternoon. Even at the poker machines, the most I could win was $600 and while it was a thrill, I knew I would put it all back in the machine but if I ended up owing $600 to friends, that was really intense. The bigger the loss, the bigger the rush.” —38-year-old male pathological gambler

After listening to dozens of compulsive gamblers in recovery groups, one thought keeps popping up and that is this: losing and then covering, or trying to cover, the losses the following day can give a bigger high than winning. While this thinking is prevalent in pathological gamblers (severely compulsive), it is also found in many problem gamblers (less severely compulsive).

The development of tolerance brought about by excessive gambling is one of the main reasons for this contradictory thinking. Most compulsive gamblers had a big win early in their gambling careers that helped trigger their addiction. Over time, the likelihood of other big wins diminishes, particularly as tolerance builds. It takes bigger bets and bigger wins to get the same high. For any gambler, big wins are few and far between, but the feelings (though negative) can be just as intense when a gambler loses a lot of money. It might take weeks to hit a jackpot on a slot machine but even a good gambler can end up a loser every night.

The neurochemistry of addiction gives a clue to this seeming contradiction. When a bet is made, the reward/reinforcement pathway is activated. The nucleus accumbens is stimulated and the user’s mind interprets this as a confirmation that what they are doing is good. The activation also urges the user to repeat the action, again and again and again. But, since the nucleus accumbens also signals relief from pain, an intense activation of this system can also be interpreted as a rush. The message that this action should be done again and again is quite similar so the pattern will be repeated.

Since one purpose of compulsive gambling is to forget past or present memories and problems, any action that keeps the mind intensely occupied and unable to feel resentment, fear or guilt is pursued.

While it appears to the non-user (in this example, a non-gambler) that dependence on a behavior or substance makes no sense, it often does just what the user wants it to do.

William E. Cohen

Knockout Mice, the Nobel Prize, & Addiction Research

Friday, October 12th, 2007

This year’s Nobel Prize in physiology or medicine was awarded to three scientists for discovering principles that allow the modification of a mouse’s genes by the use of embryonic stem cells. This is a reminder of the importance of mice in addiction research. “Knockout mice” were created in the 1980’s; these mice were missing one or more specific genes responsible for various diseases, which enabled scientists to develop research techniques and treatment protocols for human diseases. This is possible because 95% of a mouse’s genetics match that of human beings. To date, more than 500 mouse models of human ailments, including those affecting diabetes, cancer, and cystic fibrosis, along with diseases affecting the cardiovascular and central nervous systems, have been developed.

Knockout mice were available before the 80’s, but they were bred by accident. In the late 60s early 70s, Gerald Mclearen of the University of Colorado successfully isolated a strain of mice that hated alcohol and another that loved alcohol. Researchers used these mice to study the effects of stress, nutrition, and the use of alcohol on the development of alcoholism.

Experiments showed that mice genetically bred to prefer alcohol over water would drink alcohol to excess. Even 150-proof alcohol was preferred to water. The mice would drink until they killed themselves. Other experiments subjected genetically sober, alcohol hating mice to stress which mimicked human environments where violence, abuse, fear, and stress are common. The genetically sober mice came to prefer alcohol after days of this stress, probably because it relieved their anxiety and pain. These once sober mice consumed more and more alcohol and many died.

When researchers subtracted key essential amino acid and several types of B vitamins from the diet of another group of mice, those mice came to prefer alcohol to water. Finally, they force fed alcohol to sober mice who then continued to drink on their own and became alcoholic. Due to various combinations of heredity, environment, and psychoactive drugs, all the mice studied became alcoholics. When their brains were examined, the changes wrought by stress, nutrition, heredity, and by force-feeding alcohol were extremely similar.

These experiments, along with the knowledge that genetic manipulation can alter one’s susceptibility to alcohol abuse, led researchers Ernest Nobel at the University of California in Los Angeles and Kenny Blum at the University of Texas, San Antonio, to discover a gene (DRD2A1 allelle) that is more prevalent in alcoholics than in the general public (75% vs. less than 25%).

For more information on the Nobel Prize winners and a more extensive discussion of their discovery go to the official Nobel Prize site at http://nobelprize.org/nobel_prizes/medicine/laureates/2007/press.html

Marion Jones and performance-enhancing drugs

Monday, October 8th, 2007

Thoughts on the Marion Jones admission of performance-enhancing drug use.

From the Nixon-Watergate resignation, to the Clinton-Lewinsky censure, to the Scooter Libby-CIA conviction, what often trips those who skirt the law is the cover-up rather than the actual act. When Marion Jones pled guilty to using steroids to improve her athletic performance at the 2000 Olympics, the charge was “lying to federal investigators” not the illegal use of the drugs. On the courthouse steps, Marion Jones said tearfully, “I want you to know that I have been dishonest and you have the right to be angry with me. I have let my country down and I have let myself down.” Jones admitted to using tetrahydrogestrinone (THG), a synthetic anabolic steroid. She said she believed her coach Trevor Graham had given her flax seed oil.

THG, also known as “the clear,” was developed by BALCO, a San Francisco bay area laboratory that is at the heart of a doping scandal that has tarnished the reputations of a number of high-profile athletes, the most notable being Barry Bonds who broke Hank Aaron’s home run record this year. Jones testified in 2003 before a San Francisco grand jury regarding BALCO and spent the next few years defending her reputation, insisting she never used performance-enhancing drugs. Victor Conte, the founder of BALCO, testified that Marion Jones had used the drug. She, in turn, sued him for defamation of character, which resulted in an out-of-court sealed settlement.

THG is closely related to gestinone and trenbolone, anabolic steroids which were banned years ago. THG was not banned until 2003 so the question is, “Did those who used THG before 2003 do something illegal?” It probably depends on the wording of the appropriate statutes from the IOC (International Olympic committee), the NCAA (National Collegiate Athletic Association), and professional sports organizations.

Jones will probably be stripped of the gold medals she won at the 2000 Sydney, Australia Olympic Games in the 100 meters, 200 meters, and the 4×400-meter relay, and the bronze metals she won in the long jump and the 4×100 meter relay.

Jones was caught almost by chance and the question is, as with most other athletes accused of cheating, “Would they have ever confessed if they had not been caught?” To her credit, when she confessed, there was no attempt to mitigate the circumstances.

We have come a long way since Jim Thorpe was stripped of his medals from the 1912 Olympics because his amateur status was in question. (He played 2 years of semi-pro baseball for money . . . the magnificent sum of $2 a game.) Back then, amateur status was interpreted quite strictly. Performance-enhancing drugs, such as mild doses of strychnine or cocaine, were extremely rare. When the use of steroids by the Russian weightlifting team at the 1952 Olympics became known, the use of not only steroids, but amphetamines, EPO (erythropoietin), human growth hormone, and of course THG became commonplace. The various amateur and professional organizations have steadfastly limited the use of performance-enhancing drugs but the money involved in sports, not only in professional sports but also in endorsements after one’s amateur career has ended, has tempted many athletes to chance exposure and expulsion to become a “winner.”

William Cohen

Co-Occurring Disorders Conference in Yakima

Friday, October 5th, 2007

Dr. Darryl Inaba, Paul Steinbroner, and myself just returned from the 22nd Annual Co-Occurring Disorders Conference in Yakima, Washington, put on by the State of Washington Department of Social & Health Services. The themes of the conference were “Transforming Systems, Transforming lives – Integrating Care to Support Recovery. The audience of more than 400 treatment professionals, whose focus was primarily mental health and dual diagnosis treatment, spent the two days of the conference learning from 8 plenary sessions and dozens of workshops.

In one of the plenary sessions, Dr. Inaba discussed how the rapidly evolving science of addictionology provides a better understanding of compulsive behaviors and of those who are vulnerable to develop substance use disorders (SUD). The presentation explored the basic neurochemical, neurocellular, and neurofunctional anomalies that result from a “diathesis” which hijacks the brain’s control of its normal “more” and “stop” mechanisms.

In the afternoon, Dr. Inaba’s workshop focused on how recent advances in the understanding of  addiction have led to an explosive growth in medical interventions for substance use disorders (SUD). A good number of medications have already been approved to treat SUD. A much larger number are being used “off-label,” and an even greater number of medications are in the FDA New Drug Development process to treat SUD. The presentation and discussion explored some of theses medications, evaluated what is known about their current efficacy, and provided a rationale for their development.

Since mental health disorders involve the same neurotransmitters involved in substance abuse, any research involving co-occurring needs to look at how a psychotropic medications, prescribed for mental illness, will affect the client’s relationship with their drug craving. There has been more integration of mental health and substance abuse treatment for co-occurring disorders than at any time in the past but there are still many barriers to overcome.

William E. Cohen