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PubMed1998

Polydrug abuse in heroin addicts: a behavioral economic analysis.

AIM: To assess how price and income affect hypothetical drug-purchasing decisions of polydrug abusers undergoing treatment for heroin addiction. PARTICIPANTS, DESIGN AND SETTING: Forty subjects participated in experiments in which they hypothetically "purchased" drugs as price or income varied. INTERVENTION: Experiment 1 examined effects of heroin price on purchases of heroin, valium, cocaine, marijuana and alcohol. Experiment 2 examined the effects of both heroin and valium prices on purchases of these drugs. In both these experiments, income remained constant. Experiment 3 examined the effects of increasing income on drug choices, with drug prices constant. FINDINGS: As price of heroin rose in Experiment 1, heroin purchases decreased. Reductions in heroin purchases were proportionally less than price increases, demonstrating inelastic demand for heroin. Valium and cocaine purchases increased as heroin price rose, and cross-price elasticity coefficients indicated that these drugs substituted for heroin. In Experiment 2, demand for both heroin and valium was inelastic. Valium substituted for heroin, but heroin purchases were independent of valium prices, suggesting an asymmetrical substitution effect. Marijuana and alcohol purchases were independent of valium price, but both these drugs substituted for heroin. In Experiment 3 demand for heroin and cocaine was income elastic, with purchases rising in greater proportion than income. Marijuana, alcohol and valium purchases did not vary with income, demonstrating that demand for these drugs was income inelastic. Hypothetical choices were reliable both between and within subjects. Moreover, drug choices in this hypothetical situation were correlated with urinalysis results, demonstrating initial validity of this methodology. CONCLUSIONS: This methodology may be useful for understanding the phenomenon of polydrug abuse.

Adult↗
PubMed1993

A hypothesis for a common neurochemical basis for alcohol and drug disorders.

Research findings clearly support a uniform theory for a neurochemical basis of drug and alcohol addiction. Data are available that document final common pathways for addictive behaviors in the limbic system in which neurotransmitters modulate the drive states, mood, and instinctual behaviors. The specific areas in the brain implicated in the loss of control inherent in the addictive use of multiple drugs and alcohol are the ventral tegmentum, nucleus accumbens, locus ceruleus, dorsal raphe nuclei, and the periaquaductal grey area. These sites contain cell bodies and receptors for dopamine, norepinephrine, serotonin, and endogenous opiates respectively, where multiple drugs and alcohol can often produce their effects. The acquired drive of addiction that arises spontaneously, repetitively, and relentlessly is manifested in the addictive behaviors of preoccupation, compulsivity, and relapse to drugs and alcohol.

Alcoholism↗
PubMed2025

Precision Genomics: A Reality Having Universal Impact in a New Era of Psychiatry - Lessons Learned, Past and Present.

Addiction neuroscience explores the complex interplay between genetic, neurobiological, environmental, and socio-spiritual factors underlying substance and behavioral addictions. Over the past three decades, research in this domain has identified critical molecular and epigenetic mechanisms-particularly those affecting dopaminergic signaling and reward pathways-that contribute to both vulnerability and resilience to addictive behaviors. Central to this understanding is the concept of reward deficiency syndrome (RDS), first introduced by Kenneth Blum, which posits that hypodopaminergic functioning predisposes individuals to seek maladaptive rewards. Advances in neurogenetics, including the identification of key polymorphisms such as the DRD2 A1 allele, have paved the way for precision tools like the genetic addiction risk severity (GARS®) test. This test, alongside pro-dopaminergic nutraceutical interventions like KB220, demonstrates the potential for early detection and individualized treatment of "pre-addiction" risk states. Despite ongoing reliance on opioids for opioid use disorder (OUD), emerging paradigms advocate for dopamine homeostasis through non-addictive, integrative approaches. Furthermore, the integration of whole genome sequencing data can be used for Genome-Wide Association Studies (GWAS), multi-omics, and machine learning into clinical practice holds promise for advancing personalized medicine in addiction treatment. As the field progresses, addressing health equity and improving genomic representation across populations remain critical goals. This evolving framework underscores the importance of leveraging genomic insights to prevent, predict, and personalize interventions for addiction and mental illness at scale.

Disorder↗
PubMed2003

Evaluation of what parents know about their children's drug use and how they perceive the most common family risk factors.

Research on family risk factors for addictive behaviors in young people has not paid a great deal of attention to parents' knowledge of their children's addictive behaviors and of the family risk factors that affect such behaviors. The aim of this work is to compare knowledge about these two aspects in two groups of parents that differ regarding their children's declared drug use. The research was carried out with a sample of 309 schoolchildren and their families, divided into two groups: one of 154 families with children defined as non-Drug Users and another of 155 families with children defined as Drug Users. The results show that parents with children who consume drugs tend to strongly underestimate their children's use. Moreover, they overestimate the control they exercise over them and appear to be more familiarized with the use of drugs, if we compare them with parents of non-Drug Users. It is suggested that these results may be relevant for the planning of strategies that increase motivation in families with drug-risk children to participate in prevention programs.

Adolescent↗
PubMed2003

Pediatric stress: hormonal mediators and human development.

Stress activates the central and peripheral components of the stress system, i.e., the hypothalamic-pituitary-adrenal (HPA) axis and the arousal/sympathetic system. The principal effectors of the stress system are corticotropin-releasing hormone (CRH), arginine vasopressin, the proopiomelanocortin-derived peptides alpha-melanocyte-stimulating hormone and beta-endorphin, the glucocorticoids, and the catecholamines norepinephrine and epinephrine. Appropriate responsiveness of the stress system to stressors is a crucial prerequisite for a sense of well-being, adequate performance of tasks and positive social interactions. By contrast, inappropriate responsiveness of the stress system may impair growth and development, and may account for a number of endocrine, metabolic, autoimmune and psychiatric disorders. The development and severity of these conditions primarily depend on the genetic vulnerability of the individual, the exposure to adverse environmental factors and the timing of the stressful event(s), given that prenatal life, infancy, childhood and adolescence are critical periods characterized by increased vulnerability to stressors. The developing brain undergoes rapid growth and is characterized by high turnover of neuronal connections during the prenatal and early postnatal life. These processes and, hence, brain plasticity, slow down during childhood and puberty, and plateau in young adulthood. Hormonal actions in early life, and to a much lesser extent later, can be organizational, i.e., can have effects that last for long periods of time, often for the entire life of the individual. Hormones of the stress system and sex steroids have such effects, which influence the behavior and certain physiologic functions of individuals for life. Exposure of the developing brain to severe and/or prolonged stress may result in hyperactivity/hyperreactivity of the stress system, with resultant amygdala hyperfunction (fear reaction), decreased activity of the hippocampus (defective glucocorticoid-negative feedback, cognition), and the mesocorticolimbic dopaminergic system (dysthymia, novelty-seeking, addictive behaviors), hyperactivation of the HPA axis (hypercortisolism), suppression of reproductive, growth, thyroid and immune functions, and changes in pain perception. These changes may be accompanied by abnormal childhood, adolescent and adult behaviors, including excessive fear ('inhibited child syndrome') and addictive behaviors, dysthymia and/or depression, and gradual development of components of the metabolic syndrome X, including visceral obesity and essential hypertension. Prenatal stress exerted during the period of sexual differentiation may be accompanied by impairment of this process with behavioral and/or somatic sequelae. The vulnerability of individuals to develop varying degrees and/or components of the above life-long syndrome is defined by as yet unidentified genetic factors, which account for up to 60% of the variance. CRH has marked kindling and glucocorticoids have strong consolidating properties, hence both of these hormones are crucial in development and can alone produce the above syndrome. CRH and glucocorticoids may act in synergy, as in acoustic startle, while glucocorticoids may suppress or stimulate CRH, as in the hypothalamus and amygdala, respectively. A CRH type 1 receptor antagonist, antalarmin, inhibits both the development and expression of conditioned fear in rats, and has anxiolytic properties in monkeys. Profound stressors, such as those from sexual abuse, may elicit the syndrome in older children, adolescents and adults. Most frequently, chronic dysthymia and/or depression may develop in association with gastrointestinal complaints and/or the premenstrual tension syndrome. A lesser proportion of individuals may develop the classic posttraumatic stress disorder, which is characterized by hypocortisolism and intrusive and avoidance symptoms; in younger individuals it may present as dissociative personality disorder.

Aging↗
PubMedDate not supplied

Harm reduction: come as you are.

The purpose of this paper is to describe what harm reduction is, how it developed, how it works, and why it is becoming a major approach in the addictive behaviors field. Based on principles of public health, harm reduction offers a pragmatic yet compassionate set of strategies designed to reduce the harmful consequences of addictive behavior for both drug consumers and the communities in which they liver. To illustrate how harm reduction has been applied to both the prevention and treatment of addiction problems, highlights of a national conference on harm reduction are presented. The historical roots of harm reduction programs in Europe (Netherlands and the United Kingdom) are described. The paper concludes with a discussion of four basic assumptions central to harm reduction: (a) harm reduction is a public health alternative to the moral/criminal and disease models of drug use and addiction; (b) it recognizes abstinence as an ideal outcome but accepts alternatives that reduce harm; (c) it has emerged primarily as a "bottom-up" approach based on addict advocacy, rather than a "top-down" policy established by addiction professionals; and (d) it promotes low threshold access to services as an alternative to traditional high threshold approaches.

Adaptation, Psychological↗
PubMed1989

From one addiction to another: life after alcohol and drug abuse.

Once the alcoholic or drug addict has stopped drinking or using drugs, other addictive behaviors are frequently adopted. These factors must be considered in planning the overall recovery program. Substances likely to be used to excess include nicotine, caffeine, sugar, chocolate, nutritional supplements and medicinal herbs. Addictive behaviors adopted by recovering persons include eating disorders, exercise and body building, workaholism, and dependency on one's own adrenalin. Breaking the cycle of addiction requires commitment to a program of self-growth and becoming responsible for one's actions.

Compulsive Behavior↗
PubMedDate not supplied

Environments and addiction: a proposed taxonomy.

When reviewing the broad area that relates environments to addiction one is faced with an enormous volume of research with differing environmental and psychosocial factors, contrasting populations, a variety of addictive substances, and a range of addiction processes. For all these factors, there are important outcome variables. To survey this disparate literature, it is helpful to use a multiaxial model as a framework or taxonomy. In this way it is possible to see the effects that environments, broadly conceived, exert on addictive behaviors. A variety of environments is considered: interpersonal, organizational, cultural and physical, as one axis or dimension. The influence of this dimension on a second dimension relating to type of addiction is also examined. Finally, a dimension pertaining to the "life history" of addictions, from acquisition through maintenance, cessation, and relapse is considered in relation to the first two dimensions. While a variety of environmental factors affect addictive behaviors, current research indicates the need to take individual differences, cognitive mediation, and the interaction of the person with the environment into account. Significant areas that need further exploration are the failure of addictions to occur in some environments, and the development of secondary prevention approaches. Implications for intervention and directions for future research are suggested.

Cross-Cultural Comparison↗
PubMed1994

Dopamine mechanisms of cocaine addiction.

The ability of cocaine to induce a compulsive addictive behavior is the most astonishing feature of this drug. Attempting to understand the mechanisms underlying cocaine's addictive properties, two major questions should be considered: a) why and how organism's interaction with cocaine results in the development of new, drug-seeking and drug-taking behavior and b) why and how cocaine maintains this behavior when the drug is available. Since a large body of neuropharmacological evidence suggest that the mesocorticolimbic dopamine (DA) system has exclusive importance for the development and maintenance of cocaine addictive behavior, and cocaine is known to interfere in activity of this brain system, examination of mesocorticolimbic DA activity during cocaine self-administration behavior may provide some clues for understanding the drug's additive properties and regulation of this maladaptive goal-directed behavior. The aim of this paper is to discuss the literature and own experimental data on cocaine's action on the mesocorticolimbic DA system that may be involved in mediating its addictive properties. Based on these data, it is suggested that an inhibiting action of cocaine on reuptake of released DA, although essential, but not sufficient mechanism for the development and maintenance of addictive behavior. It is hypothesized, that coexistence of functionally antagonistic, inhibiting actions of cocaine on the mesolimbic DA release and reuptake of released DA may be responsible for biphasic fluctuations in DA transmission that appear to be a critical component of central oscillatory mechanism which drives and regulates cyclic drug-taking behavior.

Behavior, Addictive↗
PubMed2005

Opioid use by patients in an orthopedics spine clinic.

OBJECTIVE: Concerns regarding the efficacy, toxicity, tolerance, dependence, and abuse of opioids have limited their use for patients with chronic spine pain. In our previous study of rheumatology clinic patients, opioid analgesics were found to be highly effective, produced only mild side effects, and had few instances of opioid abuse. The purpose of this study was to replicate our previous study in another large cohort of patients with nonmalignant pain due to well-defined spinal diseases. METHODS: Opioid use was studied in 230 orthopedics spine clinic patients by retrospective analysis of prescriptions for 3 years and cross-sectional analysis of efficacy and toxicity by patient interviews. Opioid use and stability of the daily dose over 3 years were derived from computerized pharmacy records. Medical records, operative reports, and radiographic studies were reviewed to determine the reason for dosage escalations and to detect instances of abuse or addiction behaviors. Patients were interviewed to determine the efficacy, frequency, and types of side effects and instances of obtaining opioids from sources outside the Veterans Affairs system. RESULTS: Opioids were prescribed for 152 of the 230 patients, for < 3 months (short-term [STO]) in 94, > or =3 months (long-term [LTO]) in 58, and none in 72 (no opioid [NTO]). Medications prescribed were codeine, oxycodone, propoxyphene, tramadol, morphine, meperidine, fentanyl, or hydroxycodone, either alone or in combination. Interviews were completed in 72 STO, 50 LTO, and 45 NTO patients. Pain severity (0-10 scale) was not different in patients with different spinal pathologies. Opioids significantly reduced the back pain severity score from 8.3 +/- 1.5 to 4.5 +/- 2.2 (mean +/- SD). Mild side effects (most commonly, constipation and sedation) were reported by 58% of the opioid-treated patients but rarely caused them to stop taking the medication. There was no significant increase from the mean +/- SD initial opioid dosage of 5.0 +/- 12.2 30-mg codeine equivalents per day (30 mg oral codeine = 5 mg oral morphine) to the mean peak dosage of 7.9 +/- 12.5 and the mean recent dosage of 4.3 +/- 6.3, suggesting that tolerance to opioid analgesia did not appear to occur in these patients. Dosage escalations of > 2 30-mg codeine equivalents occurred 19 times in 17 LTO patients and was due to worsening of the underlying painful condition, complications of spine surgery, or unrelated surgical or medical problems in all but 3 of them (5%). These 3 patients also displayed other abuse behaviors. Abuse behaviors were not more frequent in those with or without a history of abuse/addiction. CONCLUSION: This study provides data on the efficacy, toxicity, tolerance, and abuse or addiction behaviors with opioid therapy in a large cohort of patients in an orthopedics spine clinic. The results provide objective data from patients with well-defined spine diagnoses to challenge the position that opioid treatment is inappropriate for chronic nonmalignant pain. This study provides clinical evidence to support and protect physicians treating patients with chronic musculoskeletal diseases, who may be reluctant to prescribe opioids because of possible sanctions from regulatory agencies. More important, it will benefit patients by permitting them to receive these effective, safe medications.

Aged↗
PubMed1989

Adolescent cocaine abuse. Addictive potential, behavioral and psychiatric effects.

Four hundred seventy-nine drug abusing adolescent patients enrolled in seven Straight, Inc. Adolescent Drug-Abuse Treatment Programs in five geographic regions across the United States were studied to determine the severity and patterns of cocaine abuse. Of these, 341 admitted to cocaine use and became part of this survey. Cocaine use was categorized as heavy, intermediate, or light. Areas examined were the addictive spectrum, psychosocial dysfunction, and psychiatric symptoms. Intermediate and heavy users of cocaine abused significantly less marijuana and inhalants than light cocaine abusers. Heavy and intermediate users were more likely to use cocaine intravenously and to use crack. They developed tachyphylaxis more frequently, progressed to weekly use in less than 3 months more frequently, and became preoccupied with obtaining and using cocaine significantly more frequently. They used more sedative hypnotics to calm themselves and engaged in more criminal behavior, such as stealing from parents and stores and passing bad checks. They had more arrests for possession of drugs, stole more cars, sold more drugs, and were more likely to trade sexual favors to obtain the drug. Heavy and intermediate users were significantly more psychiatrically disturbed than light users, becoming more suspicious, nervous, aggressive, and demonstrating increased symptoms of fatigue, sleeplessness, decreased appetite, and increasing cocaine dysphoria. All of these symptoms could be mistaken for psychiatric disorders. This study suggests that cocaine is as addictive in adolescents as in adults; possibly more so. It also causes psychosocial dysfunction and psychiatric symptoms. Further research into cocaine addiction among adolescents is indicated.

Adolescent↗
PubMed2002

Smoking status and the human dopamine transporter variable number of tandem repeats (VNTR) polymorphism: failure to replicate and finding that never-smokers may be different.

Cigarette smoking, like many addictive behaviors, has been shown to have a genetic component. The dopamine transporter (DAT) gene (SLC6A3) encodes a protein that regulates synaptic levels of dopamine in the brain and is a candidate gene for addictive behaviors. We have collected smoking information from a national probability sample of 3383 adult volunteers contacted via a random-digit dialing telephone interview. A subset of individuals provided DNA from cheek swabs returned via the mail for subsequent genetic analysis of self-reported smoking behavior. DNA samples were genotyped at a variable number of tandem repeats (VNTR) polymorphism in the 3'-untranslated region of the DAT gene. If we classify smokers as non- (<100 cigarettes), former and current, we fail to replicate both Lerman et al. (Health Psychology 18:14-20, 1999) and Sabol et al. (Health Psychology 18:7-13, 1999) and support the absence of effects found by Jorm et al. (American Journal of Medical Genetics (Neuropsychiatric Genetics) 96:331-334, 2000). When we distinguish between never-smokers (no cigarettes ever) and non-smokers (1-99 in lifetime), we find a reliable trend essentially in the opposite direction from Lerman et al. (1999), with the 10-copy allele being more frequent in never-smokers. Biobehavioral research on cigarette smoking should distinguish between never- and non-smokers. We have also developed an improved set of polymerase chain reaction conditions to increase the frequency of successful amplification of DAT'sw VNTR, which is a long, G+C-rich repeat.

Adult↗
PubMed1996

What is a relapse? Fifty ways to leave the wagon.

Binary thinking has often guided research and practice in the addiction field. For example, emphasis has been given to identifying whether an individual is "alcoholic" or not, and the dichotomous judgement that a client is either drinking or abstinent has been used to judge treatment effectiveness. Research on the nature of alcohol problems, however, indicates that they lie along several modestly interrelated continuous dimensions of severity, rather than occurring as a single syndrome qualitatively distinct from normality. Similarly, changes in addictive behaviors in general, and treatment outcomes in particular, are complex phenomena not readily captured by dichotomous classification. The term "relapse" is itself seriously problematic in various ways, and its definition elusive. It represents a somewhat arbitrary binary judgement imposed on the flow of behavior, and carries negative evaluative overtones. A potentially detrimental abstinence violation effect is implicit in the very use of the term "relapse", which thereby may become a self-fulfilling prophecy. Further, it implicitly pathologizes what is in fact a rather common event in the course of behavior change, and embodies an unrealistic and inaccurate conception of how successful change occurs over time. For these reasons, it may be useful in research and clinical practice to abandon the notion of "relapse" and focus instead on terminology that better describes the normal resolution process for addictive behaviors.

Alcoholism↗
PubMed2003

Pavlovian conditioning with ethanol: sign-tracking (autoshaping), conditioned incentive, and ethanol self-administration.

BACKGROUND: Conditioned incentive theories of addictive behavior propose that cues signaling a drug's reinforcing effects activate a central motivational state. Incentive motivation enhances drug-taking and drug-seeking behavior. We investigated the behavioral response to cues associated with ethanol and their interaction with operant self-administration of ethanol. METHODS: In two experiments, rats received operant training to press a lever for a sweetened ethanol solution. After operant training, the animals were given Pavlovian pairings of a brief and localized cue light with the sweetened ethanol solution (no lever present). Lever pressing for ethanol was then re-established, and the behavioral effects of the cue light were tested during an ethanol self-administration session. RESULTS: The conditioned responses resulting from pairing cue lights with the opportunity to ingest ethanol had three main effects: (1) induction of operant behavior reinforced by ethanol, (2) stimulation of ethanol-seeking behavior (magazine entries), and (3) signal-directed behavior (i.e., autoshaping, or sign-tracking). Signal-directed behavior interacted with the other two effects in a manner predicted by the location of the cue light. These conditioned responses interact with operant responding for ethanol reinforcement. CONCLUSIONS: These findings demonstrate the importance of Pavlovian conditioning effects on ethanol self-administration and are consistent with conditioned incentive theories of addictive behavior.

Animals↗
PubMed1991

Refining models of dependence: variations across persons and situations.

Having established that tobacco smoking is addictive, research should proceed to refine our models of dependence on nicotine and other drugs. Current theories of addiction do not account for between- or within-subjects variations in addictive behavior. Recent evidence that some people can smoke for decades without developing dependence demonstrates the potential for individual differences in vulnerability to dependence. Study of such anomalous smokers may provide insight into the mechanisms underlying nicotine dependence. Current theory and data also fail to provide adequate accounts of situational variation in addictive behavior and of the developmental progression from initial experimentation to dependence.

Humans↗
PubMed2005

Description of a domestic violence measure for Puerto Rican gay males.

A sample of 302 Puerto Rican gay males living in Puerto Rico and New York participated in this study with the objective of assessing the prevalence of domestic violence. A self-administered questionnaire was developed addressing issues of intergenerational violence, addictive behaviors, and domestic violence in three dimensions: emotional, physical, and sexual violence. The results concluded that close to half of the participants had experienced some sort of violence in their intimate relationships, have a history of being witness to domestic violence in their family of origin, and had identified in themselves and their families, addictive behaviors. Other variables measured are HIV and sexual coercion, drug and alcohol abuse, and levels of acculturation among participants living in the United States. The main objective of this work is to describe the development of the instrument used in the study. Based on the results of this study we describe the psychometric characteristics and content of the final questionnaire. Final recommendations are made for other researchers interested in doing domestic violence studies with Latino gay men and men who have sex with men.

Adult↗