Sober N Clean

Cocaine addicts often suffer a downward emotional spiral that is a key to their craving and chronic relapse. While researchers have developed animal models of the reward of cocaine, they have not been able to model this emotional impact, until now.

Regina Carelli and colleagues report experiments with rats in which they have mimicked the negative effect of cocaine addiction and even how it drives greater cocaine use. They said their animal model could enable better understanding of the emotional motivations of cocaine addiction and how to ameliorate them.

The researchers reported their findings in the March 13, 2008, issue of the journal Neuron, published by Cell Press.

The researchers started with the well-known phenomenon that rats will tend to avoid a taste that is paired with self-administration of a drug such as cocaine. Also, it was known that the greater avoidance of the taste was associated with greater drug self-administration.

In their experiments, the researchers squirted a grape- or orange-flavored sweet solution into the mouths of rats. After squirting one flavor, the rats were given a chance to press a lever to obtain cocaine; after the other taste, pressing the lever delivered only a saline solution.

The researchers measured the rats' response to the flavors by analyzing video of their expressions and measuring the electrical activity of a muscle involved in the licking response.

They found that the rats developed an aversion to the normally enjoyable taste that was associated with cocaine, compared to the saline-associated taste. They also found that the greater the measured aversion, the quicker and more frequently the rats pressed the lever to obtain cocaine.

The researchers also found that the aversive taste excited activity in a brain region called the nucleus accumbens, which is associated with expression of motivated behaviors.

The researchers wrote that their findings demonstrated that it is possible to induce a "negative affective state" in the animals that predicts the motivation to take cocaine. They said their finding "also is provocative because it bridges two well-known drug-abuse phenomena. The first, that drug-associated cues elicit drug seeking, has been well documented in humans and animal models. The second, that negative affect drives drug seeking, has been well described by human addicts but is difficult to model in animals. The importance of this study lies in this animal model's potential to define and then ameliorate the motivational properties of negative affect evoked by drug-associated stimuli and thereby decrease the drive for the drug," they wrote.

In a preview of the article in the same issue of Neuron, Donna Calu and Geoffrey Schoenbaum wrote that the relationship between the taste aversion and increased drug taking "lends strong support to the proposal that triggering of aversive affective states by drug-associated cues plays a role in drug-seeking behavior and provides a novel behavioral model in which to investigate the circuit basis of this phenomenon."

source: medilexicon.com

Brain scans have revealed a possible biological basis for cocaine addiction which may explain why some get hooked, while others can use the drug socially.

The scans show cocaine alters parts of the brain controlling behaviour and appropriate decision-making.

In effect, the drug messes with what is colloquially known as willpower - with some maybe more vulnerable than others.

Trinity College Dublin researchers will present their findings to a Royal Society meeting.

The researchers took brain scans of cocaine users while they performed computer tasks.

They found that cocaine increased activity in areas of the pre-frontal cortex.

The scans also revealed differences in brain structures of cocaine users.

It is unclear whether the differences existed before they started taking cocaine, or were a result of using the drug.

But the findings raise the possibility that differences in brain structure render some people potentially more vulnerable to the effects of the drug.

Lead researcher Dr Hugh Garavan said previous research into drug abuse had tended to focus on the emotional aspects of addictions - such as pleasure seeking, craving and withdrawal.

The latest study suggests that it is not simply these emotions that are affected by cocaine, but the way the brain deals with them, and keeps them in check by controlling a person's actions.

Better treatment

He said: "This research helps us move away from thinking of drug dependence as a moral weakness and allows us to see it as more of a medical condition.

"Understanding the role that our brain plays in addiction may also have important implications for treating long-term addiction and designing intervention therapies.

"Importantly, new medication based on certain chemical processes in the brain could be developed as currently there are no good pharmacological treatments for cocaine.

"Traditional treatment therapy such as counselling or rehab could also be adapted to train addicts to monitor their behaviour and practice impulse control."

Dr Gerome Breen, of the Institute of Psychiatry, said: "We now know that the effects of cocaine on the brain are multi-facetted.

"Dr Garavan and his collaborators have shown convincingly that the brain regions controlling impulse control have their activity altered by cocaine.

"This aids in our understanding of cocaine's effects and, thus, the causes of cocaine addiction."

Source: BBC News

THE biggest study of heroin and cocaine abuse in years has been launched amid new indications that Scotland's drugs crisis is now worse than ever.
The Scotsman understands that the number of people who died from drug overdoses last year is likely to be well over 400, and could be the highest ever.

There were 421 drug-related deaths recorded in 2006, a record figure that compared with 336 the previous year.

The need for toxicology reports to confirm causes of death means the final 2007 figure will not be known for some months. But The Scotsman understands that by the beginning of October the figure was about 20 higher than that for the same period the previous year.

It had been hoped that the unusually high number of drug deaths in 2006 would turn out to be a blip, but the indication that the number of deaths last year is likely to be even higher has raised serious concern that it could be part of a trend.

The Scottish Government has now commissioned a massive study into the number of heroin and cocaine users.

The study, which is costing about £175,000 and will be led by Dr Gordon Hay, from the Centre for Drug Misuse Research at Glasgow University, is the first of its kind since 2003.

That research concluded that there were 50,000 serious drug users in Scotland – about 1 per cent of the population.

But nobody knows what the current scale of class A drug use is. Experts say this is hampering action to tackle a drugs problem that is among the highest in western Europe.

Dr Neil McKeganey, the centre's director, yesterday called for an independent review of drug misuse.

"If the drug death figures show an increase on the previous year, or are even on a par with 2006, it really must generate a very detailed review of the thrust of our drug treatment services in Scotland," he said.

Tom Wood, chairman of the association of drug action teams in Scotland, warned it would take years to turn around the number of drug deaths.

"It's going to be difficult to envisage a great reduction in drug deaths in the next year or so because the people who are dying are dying at the end of a substantial career of drugs use. The typical profile is a 38-year-old man who has a ten year history of drug and alcohol abuse.

"They're usually not dying because of what they did yesterday, they're dying because of what they did for the last ten years."

A spokesman for the Scottis
h Government said: "We are determined to ensure better quality data and recording systems to monitor and evaluate best practice in treatment.

"We also want to see the development of a more robust national evidence base."

GRIEVING SISTER URGES HELP

THE sister of a man who died from a heroin overdose called yesterday for more support for addicts.

Kevin Morgan, 30, was found dead in the toilets of a McDonald's in Edinburgh last September, days after he was released from a short prison sentence for stealing to fund his habit.

Tracey Johnston, 36, of Gifford, East Lothian, said her brother's life had spiralled downwards following the death of their mother. She said: "The prisons are getting better at stopping drugs getting in, but I don't think there's enough support when they come out. He was just a lost soul. He had a heart of gold when he wasn't on drugs."

source: The Scotsman

Baylor doctors say shots block the drug's high

The needle may be one of addiction's enduring symbols, but two Houston researchers hope injections of modified cocaine actually provide the first-ever medication for people hooked on the destructive drug.

The Baylor College of Medicine scientists have developed a cocaine vaccine, currently in clinical trials, that stimulates the immune system to attack the real thing when it's taken.

As a result, cocaine no longer provides a kick.

"For people who have a desire to stop using, the vaccine should be very useful," said Dr. Tom Kosten, a psychiatry professor who was assisted in the research by his wife, Therese, a psychologist and neuroscientist. "At some point, most users will give in to temptation and relapse, but those for whom the vaccine is effective won't get high and will lose interest."

Kosten, who joined Baylor 18 months ago, asked the Food and Drug Administration in December to green-light a multi-institutional trial to begin in the spring. It presumably would be the final clinical hurdle before the vaccine might be approved for treatment.

Approval would mark a breakthrough in the treatment of cocaine addiction, which now mostly involves psychiatric counseling and 12-step programs. Over the years, Kosten notes, more than 50 pharmaceutical options have been investigated and found wanting.

The vaccine also could raise interesting ethical questions involving who should get inoculated and what happens if confidential information about those receiving it becomes known. Although developed for therapeutic purposes — the number of cocaine addicts in this country is estimated at more than 2 million — the vaccine eventually is expected to be used for prevention, as well.

The questions include whether parents would be allowed to have their children inoculated; whether it would amount to coercion to make it a condition for lighter criminal sentences; whether employers might happen upon such information and use it discriminatorily; and whether to use it on pregnant addicts to protect the fetuses.

The questions don't just reverberate about this vaccine: Tom Kosten also is at work on vaccines for methamphetamine, heroin and nicotine. Two other nicotine vaccines are being investigated by other scientists.

"Anti-drug vaccines may provide an important weapon against addiction," said Frank Vocci, director of treatment research and development at the National Institute of Drug Abuse, which funded much of the research. "We're starting to see progress. We just need to see more."

Concept called 'clever idea'
No one denies the extent of the problem. Federal estimates put the number of Americans classified with substance abuse or dependence at 22.2 million and the cost to the country at $484 billion a year — almost three times the cost of cancer.

The Kostens' cocaine vaccine has been more than a decade in the making.

In concept, the idea seems simple. Cocaine (and many other drug) molecules are so small the immune system fails to recognize them and make the antibodies necessary to mount an attack. To help the immune system, Kosten attached inactivated cocaine to the outside of inactivated cholera proteins.

In response, the immune system not only makes antibodies to the combination, which is harmless, but also recognizes the potent naked drug when it's ingested. The antibodies bind to the cocaine and prevent it from reaching the brain, where it normally would generate the highs that are so addictive.

"It's a very clever idea," says David Eagleman, a Baylor neuroscientist. "Scientists have spent the last few decades figuring out reward pathways in the brain and how drugs like cocaine hijack the system. It turns out those pathways are difficult to rewire once they've seen the drug. But the vaccine just circumvents all that."

Kosten says the idea goes back to the 1950s, when scientists devised a vaccine to treat potentially fatal overdoses of the then-popular heart medication digitalis, and the 1970s, when researchers experimented with a heroin vaccine before abandoning it.

Kosten took up the idea in the mid-1990s, figuring cocaine was a better candidate because the enzyme for breaking it down is in the bloodstream, not the liver, like most drugs. While they were at Yale, he led the clinical trials and his wife conducted the animal experiments.

The most impressive result involved a study at Columbia University in New York, where users who had no interest in being treated were paid to be vaccinated. Those who got a low dose saw little change. Those who got a high dose reduced their drug use by more than 50 percent. In Kosten's words, "it didn't do what it used to do."

But one expert warns against expecting too much.

"Addiction vaccines are a promising advance, but it's unlikely any treatment in this field will work for everyone," said Dr. David Gorelick, a senior investigator at the National Institute on Drug Abuse. "Still, if they prove successful, they will give those working in drug addiction an important option."

To be sure, the vaccine is still a work in progress.

There also are questions about dedicated users' ability to overcome the vaccine if they ingest more cocaine than the immune system can fight off, and whether they'll simply switch drugs once they stop getting a high from cocaine.

FDA may act in a few years
Kosten acknowledges those are concerns. But he also notes that most users would have a hard time affording the amount of cocaine necessary to override the immune response, and that study participants didn't switch drugs when the cocaine lost its effect. Vaccines also could be combined — as is done with mumps, measles and rubella — if the concept pans out.

Vaccines' ethical concerns have occasioned academic papers, committee investigations and conferences. In a 2004 report, the National Academy of Sciences' Center for Studies of Behavior and Development lauded the new method's promise, but cautioned that it "poses distinct behavioral, ethical, legal and social challenges that require careful scrutiny."

"There are certainly important issues there, but I don't think any are insurmountable," said Dr. Peter Cohen, a Georgetown law professor and chairman of the District of Columbia Medical Society's physician health committee. "Overall, the benefits to society of such vaccines would outweigh the risks."

Addicts also will benefit from other treatment at the same time, such as behavioral therapies or counseling, says Kosten. Emphasizing that there was a reason drugs were used in the first place, he says the vaccine is not meant as "a stand-alone treatment."

Still, FDA approval could come within a few years, Kosten speculates, if he gets the go-ahead to conduct the Phase III trial next year and it succeeds. The trial would enroll about 300 patients at six sites around the country, one in Houston.

So, what will it mean to Kosten if and when that approval comes down?

"It'll be great," he said. "It'll also mean a new opportunity to make more vaccines and move on to more addiction problems."

By TODD ACKERMAN
Copyright 2008 Houston Chronicle

We need a thoughtful approach to tackling our so-called cocaine crisis rather than overhyping the problem or opting for legalisation, argues Patrick Kenny

It is clear for all to see that Ireland has a growing cocaine problem which we must face in a sensible and coherent manner. But in the process of tackling the problem, we must steer a careful path between two major mistakes that would make the situation worse.

The first mistake is that of normalising the problem by hyping its prevalence. The recent Prime Time Investigates programme grabbed the headlines with its findings that cocaine traces can be found in most pubs and nightclubs. But that is a long way from showing that most individuals take cocaine. If we create the impression that "everyone" takes cocaine when they clearly don't, and if we communicate the idea that cocaine use is now the expected behaviour for young people, we can make the problem worse because of the powerful effect of social norm perceptions on human behaviour.

The second, and even greater, danger is to indulge in poorly thought-out policy reactions that will have the ultimate effect of making the problem worse. That's why arguments about legalising cocaine and other drugs, must be rejected.

One of the arguments for legalisation is that state controls would put the crime lords out of business. But there is absolutely no evidence for this. Do we really believe that the gangs who have made millions, and who are prepared to kill to protect their narcotic empires, will simply walk away and retire?

At what age should children be allowed to buy legal cocaine? One study released earlier this year indicated that 40 per cent of Irish 15-year-olds have dabbled in illegal drugs. Should cocaine be legal for kids of this age? Unless we make cocaine more freely available than alcohol and tobacco, and place no age limits on it, a black market for underage cocaine will remain. In such a scenario, what's to stop our drug lords killing each other to capture the teen coke market? And what if the cocaine magnates diversify into other banned substances, creating a new, expanded market where they won't have to compete against the local cocaine-selling pharmacy? Do we really want expert drug pushers pursuing our teenagers in this way? What about the cost of legal cocaine? What's to stop the criminal gangs from undercutting the price of legal cocaine?

But even if, in some alternative reality, the decriminalisation of cocaine would reduce crime, we still face a choice between two major evils and must ask ourselves which of them is the lesser: gangs wiping each other out or the prospect of even greater drug abuse and death in the rest of the population due to decriminalisation?

Legalising cocaine would inevitably increase drug consumption levels and with them, drug-related tragedies because the law plays a significant role in influencing human behaviour. Of course, it is peers that have the most intensely powerful impact on our behaviour, precisely because friends help to establish the social norms. But if this potent peer pressure has already led to a significant cocaine problem, how much greater would our problem be if the State endorsed cocaine?

Britain, in taking a softer approach to marijuana, has seen a 22 per cent increase in hospital admissions of cannabis users. The Netherlands, with its enlightened drugs policy, has seen a dramatic rise in heroin use since soft drugs were legalised. Meanwhile, Sweden, with some of the toughest drugs laws has Europe's lowest consumption rate.

After the recent cocaine-related death of Kevin Doyle, 21, of Waterford, his family said that they "sincerely hope that no family has to suffer the pain that we are going through".

Can we really believe that a dangerous experiment with legalised cocaine would help their wish to come true?

Patrick Kenny is a lecturer in marketing in the Dublin Institute of Technology.
source: http://www.independent.ie/