Tag Archives: Addiction

Pakistani Clinic ‘Treats’ Drug Addicts With Beatings and Torture

Hashish addict Noor Rehman has spent three years chained to a concrete slab covered by insects.
Beaten and malnourished, he lost his eyesight in a “clinic” run by a Pakistani mullah claiming to cure addicts who were kept against their will and forced to recite the Koran.

“They treated us worse than animals,” the 30-something with a salt and pepper beard muttered among a room full of mullah Maulana Ilyas Qadri’s last remaining patients, all clapped in irons.

When police broke into the clinic last week in Haripur, a city built on a hill around 80 kilometres north of Islamabad, they found 115 ‘patients’ chained in pairs and shackled to the ground.

Most have now been freed and Qadri has been arrested, but around 20, including Noor, are waiting for their families to come and take them home.

The clinic’s methods fall on the more extreme end of the spectrum — even for Pakistan — but offers some insight into how the conservative Islamic nation deals with the taboo subject of drug addiction.

Observers say a lack of legal oversight allows such institutions as well as some mental asylums to become places where families can ‘do away’ with inconvenient relatives.

To prevent inmates from escaping and getting back on to drugs, Qadri left them permanently chained, day and night — except for a few precious moments to go to the bathroom, still chained to their partner.

If they uttered a word of complaint, they were beaten by the mullah and his four guards.

– ‘No therapy, just chains’ –

“They tortured us! By the end of it, patients developed mental issues,” said Noor, who lost his sight eight months ago after two years of confinement.

“It was due to psychological pressure and stress,” he said. Unhygienic conditions where an eye-infection would likely go untreated may have also played a part.

Noor’s brother took him to the centre after discovering his hashish addiction. But he could never imagine himself being imprisoned, let alone becoming handicapped as a result.

Like many other “patients” he blames his family — in this case his brother, who he accuses of leaving him at the centre so he could steal his lands.

Shafiullah, an Afghan refugee with a sinewy physique and bright, turquoise eyes, added: “There was no therapy here, just chains.

“The mullah lets us go out only when he wants our help in construction work. It was us who built these walls,” he said, still chained to a fellow patient.

Others said they were forced to cook and clean in the absence of staff.

Many became addicted to the widespread and — at 50 US cents a hit — cheap drug, with Pakistan a hub for opium smuggled in from neighboring Afghanistan since the 1980s.

Today, Pakistan has more than four million cannabis consumers and more than 860,000 heroin users, a figure which has doubled since 2000 according to a recent UN survey.

Many detoxification clinics offer primitive therapies. Some isolate their patients behind bars — but it is unusual for them to be deprived of their freedom.

– ‘Nothing to do with Islam’ –

A complaint by the family of one patient at Qadri’s clinic led to a police raid and his downfall. Locked up at Haripur police station, the incarcerated mullah continued to defend his controversial methods, even as he faces the prospect of jail time for torture and illegal confinement.

“I recite the Koran, then blow on water and give this water for drinking three times a day. Normally the addicts who stop using have the tendency to vomit and shake. But thanks to the Surah Yassin (a verse) they don’t have problems,” said the self-proclaimed healer.

“And then one week, without any medicine, they are better. Even in the top institutions you will never see this,” he boasted, while calling himself a victim of police corruption for failing to pay them a bribe.

“He chained us and beat us with a stick. This has nothing to do with Islam,” responded ex-patient Shafiullah.

The controversial mullah was previously arrested in 2006 for imprisoning patients in his clinic. But he was released under bail and then acquitted.

He then re-opened his centre where his shock therapy costs each family Rs8000 ($80) per month.

During family visits, patients were instructed to say “everything is okay, else they would be beaten” said Mehboob Khab, head of the police station where the Mullah is jailed.

But his controversial methods also found approval among many families.

“When he’s chained up, my son cannot escape. These chains are doing him good, and on top of it he has learnt to recite the Koran,” said a man called Sultan, who was outraged by the closure of the centre.

Niaz, who came to pick up his brother Lutuf, said the treatment was necessary. “My brother needed this severe treatment. Without it he would get back on the drugs.”

Lutuf stared blankly into space for a moment before responding.

“My brother doesn’t know the whole story. I know what happened here.”

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A Different Path to Fighting Addiction

When their son had to take a medical leave from college, Jack and Wendy knew they — and he — needed help with his binge drinking. Their son’s psychiatrist, along with a few friends, suggested Alcoholics Anonymous. He had a disease, and in order to stay alive, he’d have to attend A.A. meetings and abstain from alcohol for the rest of his life, they said.

But the couple, a Manhattan reporter and editor who asked to be identified only by their first names to protect their son’s privacy, resisted that approach. Instead, they turned to a group of psychologists who specialize in treating substance use and other compulsive behaviors at the Center for Motivation and Change.

The center, known as the C.M.C., operates out of two floors of a 19th-century building on 30th Street and Fifth Avenue. It is part of a growing wing of addiction treatment that rejects the A.A. model of strict abstinence as the sole form of recovery for alcohol and drug users.

Instead, it uses a suite of techniques that provide a hands-on, practical approach to solving emotional and behavioral problems, rather than having abusers forever swear off the substance — a particularly difficult step for young people to take.

And unlike programs like Al-Anon, A.A.’s offshoot for family members, the C.M.C.’s approach does not advocate interventions or disengaging from someone who is drinking or using drugs. “The traditional language often sets parents up to feel they have to make extreme choices: Either force them into rehab or detach until they hit rock bottom,” said Carrie Wilkens, a psychologist who helped found the C.M.C. 10 years ago. “Science tells us those formulas don’t work very well.”

When parents issue edicts, demanding an immediate end to all substance use, it often lodges the family in a harmful cycle, said Nicole Kosanke, a psychologist at the C.M.C. Tough love might look like an appropriate response, she said, but it often backfires by further damaging the frayed connections to the people to whom the child is closest.

The center’s approach includes motivational interviewing, a goal-oriented form of counseling; cognitive behavioral therapy, a short-term form of psychotherapy; and harm reduction, which seeks to limit the negative consequences of substance abuse. The psychologists also support the use of anti-craving medications like naltrexone, which block the brain’s ability to release endorphins and the high of using the substance.

A 2002 study conducted by researchers at the University of New Mexico and published in the journal Addiction showed that motivational interviewing, cognitive behavioral therapy and naltrexone, which are often used together, are far more effective in stopping or reducing drug and alcohol use than the faith-and-abstinence-based model of A.A. and other “TSF” — for 12-step facilitation — programs. Results of an updated study have not yet been released.

Researchers elsewhere have come up with similar findings. In 2006, the Cochrane Library, a health care research group, reviewed four decades of global alcohol treatment studies and concluded, “No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems.” Despite that research, A.A.’s 12-step model is by far the dominant approach to addiction in America.

Jack and Wendy’s son, who is in his early 20s, began drinking to alleviate crippling anxiety and ease persistent depression. His drinking, while worrisome, was not an entrenched pattern, his parents believed. Some of Jack’s friends suggested that if their son did not attend A.A. of his own volition, the only thing Jack and Wendy could do was attend Al-Anon.

“The implication was that there was no other solution,” Jack said. “There was a great deal of sadness on their part, empathetic sadness, which in some ways was frightening in itself.”

“A lot of people credit A.A. with saving their lives,” he added. “It’s understandable that they can’t dissociate themselves from a program that worked for them. But it’s an all-or-nothing commitment for life. That really freaked me out.”

In A.A.’s literature, “alcoholism” is defined as “a progressive illness that can never be cured.” Members describe themselves as being “in recovery,” which translates to lifelong abstinence and adherence to the 12 steps mapped out in the Big Book, published four years after the organization was founded in 1935. First among them is the obligation for members to admit their “powerlessness” over alcohol. It also relies heavily on faith; God is mentioned in five of the 12 steps.

On a warm evening last month, about a dozen parents gathered to hear Dr. Kosanke describe the center’s program for families, which goes by the acronym Craft, for Community Reinforcement and Family Training. It rejects, she said, the use of three words: “addict,” “alcoholic” and “enabling,” a term often used to describe the acts of loved ones that help perpetuate unhealthy behaviors.

Instead of addict or alcoholic, she prefers the terms favored by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or the DSM-V, which says that patients suffer from “alcohol use disorder” or “substance abuse disorder,” terms that convey a spectrum of severity.

“Substance use takes on a lot of different shapes and sizes,” Dr. Kosanke said. “There are real downsides to labeling a child with a lifetime identity, when that truly may or may not turn out to be the case.”

And calling caring behavior enabling, she said, has a way of turning even acts of kindness into something negative. “Our field hasn’t done a good job of defining it in a narrow way that’s appropriate,” she said. “If you give your kid money knowing he will go buy pot, that’s enabling. If you take your kid to soccer practice, you’re encouraging healthy behavior. That’s not ‘enabling.’ ”

Part of the Craft approach has parents take care of themselves, too, said Lorraine McNeill-Popper, who volunteers for the parent hotline at the Partnership for Drug-Free Kids, a nonprofit group devoted to recovery for young people. “If you are sleep-deprived and stressed out, how can you think clearly?” she said.

Ms. McNeill-Popper has her own family history of drug abuse. Her twin brother died of an overdose, and she adopted his son, who later became a heavy marijuana user and ended up in rehab. “I tell parents, ‘It’s like when you’re on an airplane, and they tell you to put the oxygen mask over yourself first. That way you can help with the others.’ ”

The center’s approach is controversial in the recovery world. David Rotenberg, executive vice president of treatment at the nonprofit Caron Treatment Centers, a large drug and alcohol rehabilitation provider with branches in several states, cautioned against approaches that do not set abstinence as a goal.

“The majority of people who are chemically dependent would love to be able to drink and drug in a more moderate fashion,” Mr. Rotenberg said. “Most drug addicts and alcoholics would love to drink just a couple of drinks, and they try to do so, with poor results.”

The C.M.C. doctors say treatment for young people needs to be tailored for them, since teenagers and young adults are neurologically, psychologically, socially and legally different from adults, and have different treatment needs.

Dr. Wilkens founded the center with a fellow psychologist, Jeffrey Foote, in 2003. The two had worked together in larger hospital-based treatment centers where they struggled to introduce evidence-based treatments, she said. When it opened, the C.M.C. was one of the few centers in the nation that were not tethered to the 12-step model, she said.

“It was our strong belief that you can work with people at any stage of change, ranging from ‘I’m not even sure I have a substance problem’ all the way to ‘I just got out of rehab and want to go to A.A. meetings every day,’ ” Dr. Wilkens said. “We don’t have a judgment on how you address your substance use problem. Maybe A.A. is helpful to you and you find everything you need there. If it’s not, we genuinely believe there are many strategies for helping to resolve them.”

In fact, a majority of college binge drinkers do not go on to become alcohol dependent, said Stanton Peele, a Brooklyn psychologist who has studied substance use for decades and is a longtime critic of the A.A. model. While binge drinking and other drug use are risky, multiple studies show that most people “mature out” of such recklessness when they begin to have increased responsibilities.

A federally financed study of 43,000 randomly selected Americans, called the National Epidemiologic Survey on Alcohol and Related Conditions, or Nesarc, found that 75 percent of those who are heavy drinkers eventually regain control without rehab or A.A., Dr. Peele said. The survey, which was conducted in the early 2000s and was designed to be representative of the larger United States population, was aimed at helping researchers understand high-risk drinking patterns, design better-targeted treatment programs and monitor recovery. It found that over half of those who recover managed to cut back instead of abstaining, Dr. Peele said.

“Isn’t it more encouraging to know that most people are going to outgrow these habits than to think they’re going to have a disease for the rest their lives?” Dr. Peele asked. “The data show that the odds are in your favor.”

Dr. Wilkens is familiar with that pattern. She was a college binge drinker herself and also struggled with bulimia. Once she left her home state of Kansas for New York City, where she attended Hunter College, she felt culturally stimulated and intellectually challenged, she said, and the drinking and disordered eating disappeared.

“When you focus on building up the world around you, you find stimulation and rewards that are very different from using drugs and alcohol. You find other ways of soothing yourself, and things can get better,” she said.

That is precisely what L.S. learned five years ago. L.S., a Manhattan lawyer in his early 30s who asked to be identified only by his initials to protect his privacy, spent nearly a decade as an episodic binge drinker. He began drinking as a student at his large Midwestern university, where he played rugby and where many of his best friends belonged to fraternities. Alcohol, he said, flowed freely through both subcultures. L.S. said he thought his drinking — weeks of no drinking followed by serious binges of a few dozen drinks over several days — would end after college. Yet the behavior did not fade. The morning after his wedding, he awoke with a hangover that lasted a day and a half.

His father, who drinks socially, told him that people either were alcoholics or were not. But L.S. was unprepared to accept that label and began researching moderation on his own. He found a New York branch of Moderation Management, or M.M., a secular, peer-led support group that takes a cognitive behavioral approach.

In contrast to A.A., which stresses a drinker’s lack of power in the presence of alcohol, M.M. encourages personal responsibility for drinking. The group, founded in 1993, encourages members to start with an alcohol-free month, and then allows for the reintroduction of moderate amounts of alcohol. (Critics note that one of its founders, Audrey Kishline, was involved in a fatal accident while driving drunk. She left the group in January 2000 with the intention of joining A.A., and three months later, crashed head-on into another vehicle, killing the driver and his 12-year-old daughter.)

L.S. now attends hourlong meetings once a week at which he and about a dozen others discuss their goals for moderate drinking, as well as tips, challenges and progress on avoiding triggers. Since he began attending, L.S. limits himself to about five drinks a week, well below the 14 drinks M.M. advises as a safe limit for men.

L.S. is convinced that there is no single approach for all problem drinkers. “M.M. doesn’t profess to work for everybody. It has a scientifically based approach that works for some people,” he said.

The C.M.C. psychologists are blunt about the reasons many teenagers and young adults use drugs: When it comes to decreasing anxiety and relieving depression, substances tend to work for the short term. “Kids aren’t crazy for using them,” Dr. Wilkens said. “They have an effect that is reinforcing in some way. If you understand that, you can strategically work to support and reinforce other healthy, competing behaviors.”

That approach runs through the book she wrote with Dr. Foote and Dr. Kosanke, “Beyond Addiction: How Science and Kindness Can Help People Change.” It was published in February, just as the death of Philip Seymour Hoffman from a heroin overdose struck fear in the hearts of many parents whose children use drugs. It landed Dr. Wilkens on several talk shows and drew scores of calls to the center. (In addition to its New York office, the group has opened a residential treatment center in the Berkshires.)

Dr. Wilkens’s message struck a chord with Wendy. Her son had just left school, and the couple was exploring treatment options. Wired in the evenings with extreme anxiety, he drank excessively to get himself to sleep. Once in bed, he’d stay there till 5 p.m.

Before she read the book, Wendy said, she would stomp upstairs hourly to announce in an exasperated voice, “It’s 2 o’clock. You’ve got to get out of there.”

“I’d do that three or four more times and then be fuming,” she said. “I’d be fuming all day, at home doing my work and knowing he was upstairs sleeping off whatever he’d been drinking the night before.”

After learning the Craft approach, Wendy said, she stopped nagging, changing her negative, accusatory tone to a more pleasant one by asking open-ended questions.

Today, Wendy and Jack’s son is working with his psychiatrist and getting help for his depression and anxiety. He seems to be bingeing much less. When the family went out to dinner on a recent night, the parents each ordered a beer or a glass of wine and sipped slowly through dinner. “How will he learn moderation if he doesn’t see it modeled?” Wendy asked.

Ellie hopes her daughter, too, will be able to change her drinking patterns. Ellie is a New York editor, who asked that her last name be withheld to protect her family’s privacy. Her daughter, 23, has struggled with binge drinking since she was 16. While her daughter graduated from college and holds a responsible job, she still binges on weekends. “It’s so much a part of the culture, it’s everywhere,” Ellie said. “She says she’d have no social life if she stopped drinking.”

Ellie, who grew up in a home in which many relatives attended A.A., at first tried Al-Anon. “They talk about ‘disengaging,’ ” she said. “But it’s your child, and I’m not one of those people who can put her out on the street.”

While their daughter has resisted treatment so far, Ellie and her husband have begun seeing a therapist at the C.M.C. to better navigate their relationship.

“My child is much more than a label or a diagnosis,” she said. “She’s not a problem to be solved, but a child to be loved and guided toward a better life.”

Source:  The New York Times

Addiction Brain Scans, Unscrambled

We’re used to media splashes about so-called “holes” in the brain. But what neuroimaging really tells us about the effects of drug use is much subtler—and much more helpful.

We’ve come a long way since; the advent and exponential development of neuroimaging techniques allows us to visualize the mind’s hardware—and how it goes awry in addiction—in increasing detail and nuance. But the media bombardment of brightly-colored brain images can be overwhelming—and important points get lost. These slides are meant as a primer on some of the biggest stories to have emerged in addiction neuroimaging, and the insights they give. Of course, these examples are only a thin sliver of the available science—and scientists are still grappling with addiction’s overwhelming complexity. Without dismissing other relevant brain systems or equally important socio-cultural and environmental influences, our focus here is the striatum: a set of structures heavily involved in reward, motivation, habit formation—and the brain’s dopamine system.

One of the earliest addiction imaging experiments was also one of the gutsiest: in 1989 researchers set out to find what cocaine actually did in the brain, where it went, and what that meant. They tagged cocaine with a radioactive element, injected it into healthy volunteers, and used PET (positron emission tomography) to measure the location and time-course of radioactivity emitted. The result? Coke went straight to the striatum: the home of reward signaling and the formation of consequent behaviors. Here we see a horizontal brain slice over time (in minutes). The “hotter” colors represent more cocaine (the striatum is the two sickle-shaped hot-spots near the middle). The study also investigated time-course (right), showing the rapid cocaine uptake needed for a high—this paralleled the subjective effects reported by the volunteers, suggesting the two are related. The work demonstrated in humans that cocaine’s direct effects on the striatum and time-course modulate its subjective effects. The study was later repeated using methamphetamine instead (bottom row): the binding again primarily involved the striatum, but also extended to many other areas. The time-course, again paralleling subjective experience, was much longer-lasting than cocaine—explaining differences between the two stimulants in duration, subjective experience and long-term effects.

Sometimes it’s less obvious why people enjoy a drug. This recent study investigated psilocybin (magic mushrooms), a compound that binds to serotonin receptors and doesn’t have obviously rewarding dopamine effects. MRI (magnetic resonance imaging) was used to measure the magnetic properties of blood flowing into the brain, with the idea that active regions need more blood. Researchers injected volunteers with the drug and placebo, and measured changes in blood flow and oxygenation. To everyone’s surprise, MRI measures decreased with psilocybin, mainly in regions other than the striatum (yellow circle), including areas involved in association, consciousness and “constraining the experience of the world.” The scatterplot shows that the amount of decrease in MRI signal predicted the intensity of subjective effects. The study also found reduced communication between brain regions, suggesting that “decreased activity and connectivity” permits “an unconstrained style of cognition.” So some drugs without a direct striatum/dopamine effect can be found enjoyable, perhaps due more to the reward of changing perceptions—a uniquely human feature that seems hard to model in animals. In a separate study, the group also found that MRI measures related to memory vividness and subjective well-being at follow-up, suggesting a biological basis to the proposed use of psilocybin in psychotherapy.

One of the most consistent “hallmarks” of addiction is that levels of the D2 subtype of dopamine receptors (mostly found in the striatum) are lower in addicted than in non-addicted individuals. These images come from a number of PET studies which assessed D2 receptor levels, by injecting subjects with a radioactive compound that specifically binds to dopamine receptors and comparing levels between groups. The “cooler” colours indicate lower D2 levels in the addicted groups. This represents the possible identification of an addiction “biomarker”—an objective biological measure that can be investigated, monitored and perhaps manipulated for prevention or treatment. The real-world relevance of this is shown in the pink inset: in two studies (cocaine and meth), addicted subjects had their D2 levels measured, went through treatment, and were then contacted again to assess treatment success. Successful responders to treatment were found to have higher D2 levels than those who had relapsed, suggesting that D2 levels have some predictive value for success. Much remains to be filled-in in the dopamine receptor/treatment response black box. But this knowledge can help in the allocation of clinical attention and resources, or the identification of patients who may benefit from one type of treatment—like meds to increase dopamine transmission—over another.

The D2 dopamine receptor has also been used to investigate signs of recovery after abstinence. In this PET image, the “cooler-coloured” striatum of a one-month-abstinent meth user shows lowered binding of the radioactive compound, suggesting fewer receptors. But the striatum grows “bright” again after 14 months’ abstinence, suggesting increase in D2 receptor availability, or recovery of the receptors. This implies that brain cells don’t necessarily disappear permanently, but may temporarily adapt (perhaps retracting receptors in response to the dopamine bombardment from drug use)—or else that the remaining brain cells can compensate. Unfortunately, behavioral tests in the same study didn’t improve as much as D2 measures, and the finding has been difficult to replicate, which limits the study’s implications—but it does show the importance of timing in studies, and suggests that neurochemical changes aren’t necessarily permanent. (By the way, the black spots in the 14-month image are not holes in the brain, but a result of assigning colors to values, and setting the threshold at a certain level).

One problem with neuroimaging is that the pictures often don’t reveal much about functional relevance. How, if at all, do receptor levels translate to differences in experience, behaviour, thinking or feeling? This PET study measured the relationship between dopamine receptors and personality traits. The striatum blobs shown here don’t display radioactivity indicating D2 receptor levels, but rather the strength of the correlation between receptor levels and trait impulsivity (“hotter” colors mean a tighter relationship). In both meth-dependent and healthy subjects, the measures correlated inversely: those with the lowest D2 receptor availability were the most impulsive. This shows that dopamine receptor availability in the striatum can contribute to personality traits for the entire population—and addicted individuals, who tend to be on the low end of the D2 spectrum, are more likely to act impulsively than non-addicted individuals. It’s still frustratingly hard to determine what came first: drug use could cause a decrease in D2, or alternatively, low D2/high impulsivity could make people likelier to use drugs. Still, the study gives the “low D2 addiction biomarker” some behavioral meaning. It also explains some aspects of initiating or continued drug use, and raises clinical implications—as personality traits can be easily assessed and maybe used to evaluate dopamine-related intervention strategies.

Genetic factors contribute significantly to addiction, and imaging techniques can pick up and visualize genotype effects that less sensitive behavioural or self-report measures may not. This study investigated how genetic variation in the dopamine system affects smoking. Dopamine release in a certain part of the striatum is often considered the brain’s reward signal, and can be assessed in humans using PET. This requires measurement of a dopamine receptor-binding radioactive compound at two time-points; the difference between the points shows how much dopamine was released over time, knocking the compound off the receptor. The lower the second PET signal, the more dopamine was released. Subjects were scanned before and after a smoke break, then divided by genotype for three components of the dopamine system—each of which varies in function depending on genotype. Each row on the slide is a component: top, the dopamine transporter; middle, the D4 dopamine receptor; bottom, an enzyme that removes dopamine after release. For all three components, individuals with one genotype (left two panels) released more dopamine during the smoke break than those with another genotype (right two panels). So some people, due to their genetic makeup, find smoking more rewarding than others—and are likelier to continue or escalate use. Tiny biological differences can influence addiction processes, and a better understanding of them can aid prevention and intervention.

Behavioral or process addictions, like compulsive gambling, eating, or sex, have been getting lots of neuroimaging attention, partly due to their surface similarities with drug addiction, but their neurobiology remains largely unexplored. These results from several PET studies measuring D2 dopamine receptors in the striatum show that obese individuals who may be prone to compulsive overeating have low D2 levels—paralleling findings in compulsive drug users. This suggests biological commonalities between behavioural and drug addictions; it’s an exciting area currently gaining research momentum. Interestingly, in compulsive gambling—the only behavioural compulsion currently proposed for re-classification to addiction—low D2 receptor levels haven’t been found, although several studies have searched. This may mean that low D2 levels are sufficient, but not necessary, to drive addiction, and that other factors play a more important role here—or that the low D2 levels seen in drug addicts relate to the effects of drugs themselves, rather than addiction per se. This is a unique chance for scientists to learn about addiction without the potentially interfering effects of drugs, but clinically there are potential problems: drug addiction treatment options may have different effects when aimed at behavioural addictions. Of course, other biological parallels with drug addiction have been identified, and neuroimaging has played an important role in teasing apart the results.

Neuroimaging has enabled many advances in addiction science; it’s also added to the debate on personal culpability in addiction, by highlighting neurobiological factors that aren’t necessarily under our control. But the emotive influence of these images can also be used to more sinister effect, manipulating audiences into knee-jerk reactions. Sometimes this is done for the sake of eyeballs and obviously overwrought (right panel)—but other uses are more serious, including court evidence to support drug-related penalties. Even if an image comes from reputable scientific sources, it’s still subject to interpretation and presentation, which can easily be shifted to fit different needs. So we’re well advised to approach these images with questions. What is actually being shown? What do colors (or their absence) mean? What’s the behavioural significance, if any? And who is being shown? Is this a group of individuals, or one exemplar—and if the latter, is he or she representative of the population, or does the image pit the best in one group against the worst in another? How many times did they use the drug, how heavily, and how long were they abstinent? Could factors other than drug use account for the image? The answers may not be easy to come by. But posing these questions can help overcome gut responses, fostering a fuller, fairer understanding.

In the previous photo, even though the news article claimed to have “conclusively demonstrated severe and multiple disruptions,” the “black holes” don’t indicate dropout of actual brain tissue. They’re a result of threshold-setting: assigning “black vs. colour” at a particular signal value, with the choice of value entirely subjective. This is just one of the many caveats of neuroimaging. In human neuroimaging, for example, actual photographs are rare; more often, images are proxy signals for some biological event that have been digitized and computerized, reconstructed and transformed, and subjected to statistical testing and interpretation. Signals are small, assumptions are many, and at every point, a person intervenes in producing what will ultimately be displayed. The result can sometimes be utter junk—as demonstrated in a study that flashed pictures of human social interactions, and “found” associated brain activation…in a dead fish. Neuroimaging techniques, no matter how brilliant, are removed biological events, so can’t always be assumed to accurately reflect them. Addiction neuroimaging is a tricky area: the field is fraught with political static and agenda. Combine this with the computational limitations of neuroimaging, and emotionally charged headlines can ensue. Ultimately, though, a tool that can visualize the hardware of the mind is extremely valuable in any mental health field. It’s a privilege and a thrill to think of the possibilities ahead.

Lady Gaga Admits to Weed Addiction

Lady Gaga has offered fans advice on giving up marijuana after admitting she is still struggling to kick her drug habit. The ‘Poker Face’ singer was smoking up to 15 cannabis joints a day after undergoing hip surgery earlier this year, but recently revealed she has cut down and attempted to give up. Gaga has now reached out to a fan struggling with a similar problem via her social networking website Littlemonsters.com, handing out advice and telling the devotee about her own issues. The singer writes, “You are brave. It is hard for me every day. I just didn’t want to live life high anymore. I smoked all day every day for 2 yrs (years). Careful when you are withdrawing it can make you sick. Have someone you love stay with you. I love you.”

“I won’t survive unless I get help”

The former “Baddest Man on the Planet” added to his list of bizarre public appearances with another unrestrained interview, this one courtesy of Matt Lauer of the “Today Show” who sought to find out more about Tyson’s recent admission that he’s still grappling with substance abuse issues and is “on the verge of dying.” Tyson uttered those words last Friday at a post-fight press conference for his initial venture as a boxing promoter, admitting he’s just been sober for six days.

Tyson visited that theme again on Thursday’s “Today Show” in a segment that was taped in Las Vegas with the two facing each other just a few inches apart and Tyson sometimes leaning over, as if trying to peer at Lauer’s notes.

“When I start drinking and I relapse, I think of dying,” Tyson told Lauer, in a piece that was taped on Wednesday. “When I’m in a real dark mood, I think of dying. And I don’t want to be around no more. I won’t survive unless I get help.”

Former heavyweight champ Mike Tyson tells Matt Lauer (l.) that when he's in a dark mood he thinks of dying.

Lauer’s interview with Tyson was heavily hyped on “Today,” with teases sandwiched between segments on the growing crisis in Syria and news of Valerie Harper’s ongoing battle with terminal cancer.

“I’ve been sober 12 days now and it’s tough,” Tyson said in his first public comments since Friday. “I’m mean and irritable.” Later, he spoke of his difficulties, abstaining from drugs and alcohol. “Yes, it’s a real challenge because I don’t know if I like this sober guy,” Tyson said. “It’s hard for me to live normal – straight is hard.” The interview with Lauer came on the heels of Tyson’s stunning comments on Friday that he still struggles with substance abuse issues. “I’m on the verge of dying because I’m a vicious alcoholic,” Tyson said at the post-fight press conference at the Turning Stone Resort in upstate New York. “I haven’t drank or took drugs in six days, and for me that’s a miracle. I’ve been lying to everybody else that think I was sober, but I’m not.”

The media in attendance later rose to give him a standing ovation when Tyson told them he would never use again.

Mike Tyson shocks sports community by saying: 'I'm on the verge of dying because I'm a vicious alcoholic.'

“No one’s failed more than I did,” Tyson said, choking up to Lauer. “I’m a king of the barbarians. There’s no one that could surpass me in the pain that I’ve endured. I can deal with it. I can handle it.”

In the interview’s most revealing moment, Lauer asked Tyson why he has never taken responsibility for his 1992 rape conviction that led to a three-year prison sentence in an Indiana prison. “I don’t think I have to make amends to that because I’ve done nothing,” Tyson said. “I really didn’t do anything to her. I didn’t rape her. I didn’t beat her. I didn’t do anything to her and I’m not going to make amends. I already made amends to myself. But to her, no.”

Tyson said he’s been able to put that episode behind him. “I’m at peace with myself pretty much,” Tyson said.

While Tyson is always raw and uninhibited, Lauer’s interview on Thursday lacked the visceral punch that his grilling of Alex Rodriguez attorney Joseph Tacopina had earlier this month on the show. In that one-on-one, Lauer surprised Tacopina with a letter from Major League Baseball in which the league said it was willing to waive the confidentiality clause in the Joint Drug Agreement to allow Rodriguez to discuss his drug testing history.

No such moment took place on Thursday.

“He is in complete conflict in his own mind,” Lauer said on Thursday on air of his segment. “You heard him contradict himself: He said I’m at peace with myself but earlier in the interview he said he can’t live with the guy he is and doesn’t know how much longer he’ll be alive. So there is an awful lot going on inside his mind and I think sometimes it confuses even him.”

Outside of giving the public a glimpse of Tyson’s struggles, the segment on “Today” also served as a promotional vehicle for Tyson’s many undertakings, such as his upcoming docu-series on Fox Sports 1 “Being: Mike Tyson” and his forthcoming HBO special, “Undisputed Truth,” which is a demo of his one-man play. While Lauer mentioned both projects, he chose not to bring up his own appearance on “Late Night with Jimmy Fallon” last year in which he poked fun of Tyson by sporting a fake facial tattoo in a humorous bit.

Heroin Support Group Founder Caught Dealing Dope

A Chicago-area man who helped found a heroin-abuse support group faces felony charges after allegedly selling heroin to undercover police.

Peter K. Rundo, 21, who lives near the Springbrook Prairie Forest Preserve near west suburban Naperville, was ordered held on a $50,000 bond after being charged with two felony counts of manufacture or delivery of heroin, according to records on file in Will County Circuit Court. Officials said they received word a little more than a month ago that Rundo was buying heroin in Chicago and selling it in Naperville. John Arizzi, the deputy director of the Joliet Metropolitan Area Narcotics Squad, said undercover investigators made contact with Rundo and arranged to buy the drug from him in “controlled purchases.”

Rundo allegedly met undercover officers three times in Naperville, with the third and final sale occurring about 8 p.m. Sept. 16. Arizzi said Rundo drove to the area in a silver, 2000 BMW and offered no resistance when taken into custody. The heroin, allegedly delivered each time in small, foil packets, totaled six grams, Arizzi said.

Rundo in July 2012 was convicted in DuPage County of driving under the influence of narcotics, following an arrest in Naperville. He and two friends in recent years helped found the Open Hearts/Open Minds heroin-abuse support group. Rundo also was interviewed for and appeared in a segment of the national TV program “48 Hours” on heroin abuse.

A Friend of Mine & her Victory With Vivitrol

NICOLE Kapulsky didn’t do the 12 steps.

She doesn’t go to Narcotics Anonymous meetings and tell other recovering addicts about how she trekked into North Philly’s Badlands – 5-foot-nothing, alone, petrified – to buy dope.

Or about the worst day of her life, when her ex-husband showed up at her parents’ house with police and took her children away. Or when her family turned their backs on her and she was calling rehab centers every hour to check for an open bed – only to relapse after she’d finally detoxed.

She didn’t suddenly find God and realize that surrendering to a higher power was the only way to get clean.

“I did it my way,” said Kapulsky, 35, who was introduced to heroin in 2009, after an ugly divorce, but who has been drug-free for nearly 19 months.

And, importantly, her doctor’s way.

In January 2011, after being away from her three sons for Christmas and New Year’s, Kapulsky decided that she needed to kick heroin for good. She’d seen it kill her friends. It had to stop.

“By the time I was done, I had no savings, no jewelry. I had nothing,” she said. “I couldn’t take any more of not being with my kids. It was heartbreaking for me. My kids were my whole life. That’s when I googled it. I made an appointment and went in.”

The appointment was with Dr. Richard DiMonte, an addiction-treatment specialist in Media. He uses a non-narcotic that has helped Kapulsky and hundreds of his patients reclaim their lives from prescription painkillers and heroin.

It’s called Vivitrol, a monthly injection of naltrexone that binds to human opioid receptors and blocks the drugs’ euphoric effects, so addicts can’t get high even if they want to. Kapulsky said it also stopped her drug cravings. She doesn’t even think about heroin anymore, unlike in 2010, when she relapsed after methadone treatment.

Doctors and researchers hate the term “miracle drug.” But Kapulsky says that’s the best way to describe her experience.

My family trusts me. There’s no question of whether I’m clean or not. They know that I am because I go and I get my shot every 28 days, and they know that you can’t do drugs when you’re on the shot. You just can’t do it,” she said. “It saved me. I’m not the strongest person in the world, believe me. If I wasn’t on Vivitrol, I probably would have relapsed.”

Vivitrol was approved in October 2010 by the Food and Drug Administration for the treatment of opioid dependence. Experts say it could be a game-changer in combating the increasing abuse of oxycodone and other prescription painkillers, which doctors and law-enforcement officials say is helping to create a new category of heroin addicts.

“We have a prescription-drug problem, and it’s just getting out of control,” DiMonte said. “Most of the heroin use nowadays is because people can’t afford the prescription pills they’re buying, so they convert over to heroin, which is cheaper.”

In 2010, about 12 million Americans reported that they’d used prescription painkillers for nonmedical purposes in the past year, according to the Centers for Disease Control and Prevention. Between 1998 and 2008, the reported abuse of prescription painkillers more than quadrupled, from 2.2 percent to 9.8 percent, among people 12 and older who entered substance-abuse treatment.

“It’s really taken off over the last five years. I couldn’t even begin to tell you how bad,” said a veteran officer in the Philadelphia police Narcotics Field Unit, who asked that his name not be printed because he works undercover. “It’s much easier to get started on the pills because the doctors are writing prescriptions. Nobody thinks anything of it.

“It’s a very wide range of addict,” he said. “It doesn’t just attack the poor or a certain neighborhood; it’s all over the place.”

This summer, opiate abuse was back in the news after the death of Eagles coach Andy Reid’s 29-year-old son, Garrett. He started with OxyContin as a freshman at Brigham Young University in 2002 and later began using heroin. His cause of death has not been disclosed, but Reid has said his son “lost the battle” he’d been fighting.

“These are not drugs secretly transported into the country by boat or airplane. The drugs are here,” Thomas Perricone, chief of the narcotics and dangerous- drugs section of the U.S. Attorney’s Office in Philadelphia, said of prescription painkillers. “We are seeing very organized rings where networks recruit ‘patients’ and sometimes transport them in groups to corrupt doctors’ offices.”

Vivitrol has shown promising results so far, experts say.

Instead of replacing one narcotic with another – such as methadone or Suboxone, both of which have the potential for abuse and are sold on the street alongside heroin – a monthly injection of Vivitrol forces addicts to remain clean. That enables them to participate in a support program, or, in Kapulsky’s case, one-on-one therapy, and to tackle the root causes of their addiction, which often involve mental illness.

Alkermes, the company that manufactures Vivitrol, doesn’t disclose patient data, but it says net sales of Vivitrol have increased for 12 consecutive quarters. Some doctors are using Suboxone and other medicines to taper their patients off heroin or painkillers, then switching them to Vivitrol. It could be a winning formula, recent research shows.

“These are just weapons in the arsenal, tools to help the patient. But if the underlying cause is still there, the likelihood of success diminishes considerably,” said Dr. Hani Zaki, director of psychology at Eagleville Hospital in Montgomery County, which treats substance abusers.

Zaki said the nature of addiction is still widely misunderstood. Recovery isn’t a matter of days or weeks or months, he said, “it’s always years.” Very few addicts can do a quick detoxification then go on with their life without the risk of relapse.

“The willpower and ‘just say no’ thing are really very naive. There are physical changes in the brain when you become addicted,” Zaki said. “The brain needs time to recover. Just finishing detoxification doesn’t mean that the patient is out of the danger zone.”

For Kapulsky, who now lives in Boothwyn, Delaware County, Vivitrol serves as a safety net while she pieces her life back together after she was blindsided by heroin addiction in 2009. She has regained joint custody of her children, reconnected with her sister and helps care for her 1-year-old niece. She goes to therapy once, sometimes twice, a week, and plans to take college courses to become a drug-and-alcohol counselor.

She’s happy now, and quick with a smile.

But Kapulsky said she knows four people who died from heroin this summer alone, including a close friend. She’s trying to spread the word that Vivitrol is available – and covered by many insurance plans – for people who want to get clean and stay clean.

“It’s horrible. I’ve never seen anything like this in my life, how many people are addicted to opiates,” Kapulsky said. “It’s everywhere, and nobody’s immune to it. People don’t want to believe that addiction is a disease. But it is a disease, and you know what? It’s curable.”

This is Your Disease Talking

Hello, I am your Disease

I Hate meetings…I Hate higher powers…I Hate anyone who has a program. To all who come in contact with me, I wish you death and I wish you suffering.

Allow me to introduce myself, I am the disease of addiction. I Am cunning, baffling, and powerful. That’s Me. I have killed millions and I am pleased. I love to catch you with the element of surprise. I love pretending I am your friend and lover. I have given you comfort, haven’t I? Wasn’t I there when you were lonely? When you wanted to die, didn’t you call on me? I was there, I love to make you hurt. I love to make you cry. Better yet, I Love to make you so numb you can neither hurt nor cry. When you can’t feel anything at all.

This is true gratification. And all that I ask from you is long term suffering. I’ve been there for you always. When things were going right in your life, you invited me. You said you didn’t deserve these good things, and I was the only one who would agree with you. Together we were able to destroy all the good things in your life. People don’t take me seriously. They take strokes seriously, heart attacks, even diabetes, they take seriously. Fools.

Without my help these things would not be possible. I am such a hated disease, and yet I do not come uninvited. You choose to have me. So many have chosen me over reality and peace. More than you hate me, I hate all of you who have all types of programs. Your program, Your meeting, Your higher power. All of these things weaken me, and I can’t function in the manner I am accustomed to. Now I must lie here quietly. You don’t see me but I am
growing bigger than ever. When you only exist, I may live. When you live I may only exist. But I am here…

And until we meet again, If we meet again, I wish you death and suffering.

$11 Million to Fight Youth Substance Abuse

PROVIDENCE, R.I. — Rhode Island has received an $11 million, five-year grant from the federal government to target the abuse of alcohol, marijuana and prescription drugs by teens and young adults.

The state’s Department of Behavioral Healthcare, Developmental Disabilities and Hospitals announced the award on Wednesday. The money will go toward local community efforts to prevent youth substance abuse.Statistics from 2011 indicate that 30 percent of high school students in Rhode Island report having consumed alcohol in the past 30 days. More than 6 percent report drinking and driving within the past month.Gov. Lincoln Chafee says the money will help enhance efforts to prevent dangerous abuse by some of the state’s most vulnerable citizens.

Parent’s Addictions tied to Adult Children’s Depression

Parents who are addicted to drugs or alcohol are more than twice as likely to have children who develop depression in adulthood, according to a report published online in the journal Psychiatry Research.

For the study, researchers at the University of Toronto examined the association between parental addictions and adult depression in a sample of 6,268 adults, taken from the 2005 Canadian Community Health Survey. Among the subjects, 312 had a major depressive episode within the year preceding the survey and 877 reported that while they were under the age of 18 and still living at home that at least one parent drank or used drugs “so often that it caused problems for the family.”

Parental addictions were associated with more than twice the odds of adult depression, said lead author Esme Fuller-Thomson, Ph.D., of the University of Toronto.

“Even after adjusting for factors ranging from childhood maltreatment and parental unemployment to adult health behaviors including smoking and alcohol consumption, we found that parental addictions were associated with 69 per cent higher odds of depression in adulthood,” she said. “These findings underscore the intergenerational consequences of drug and alcohol addiction and reinforce the need to develop interventions that support healthy childhood development,” said Fuller-Thomson. “As an important first step, children who experience toxic stress at home can be greatly helped by the stable involvement of caring adults, including grandparents, teachers, coaches, neighbors and social workers.

“Although more research is needed to determine if access to a responsive and loving adult decreases the likelihood of adult depression among children exposed to parental addictions, we do know that these caring relationships promote healthy development and buffer stress.”

The study was unable to determine the exact cause of the relationship between parental addictions and adult depression.

According to co-author and graduate student Robyn Katz, ”It is possible that the prolonged and inescapable strain of parental addictions may permanently alter the way these children’s bodies reacts to stress throughout their life.

“One important avenue for future research is to investigate potential dysfunctions in cortisol production – the hormone that prepares us for ‘fight or flight’ –which may influence the later development of depression.”

Source:  University of Toronto