Update on Substance Abuse and Addictions
June 26, 2017   

Some of the highlights from the 2017 American Psychiatric Association (APA) Annual Meeting include our current understanding of psychological and biological addictions, the synthetic drug or “bath salts” epidemic, and the rise in prescription/synthetic opioid abuse/addiction. The most current treatment options and most effective approaches for the management of addiction were also discussed

At a presentation by Dr. John Douglas, Dr. Timothy Fong, and Dr. Brian Hurley, current treatment options for behavioral addictions were discussed. The lecture focused on addictions such as gambling, internet gaming, food, and shopping. The most effective pharmacological options currently available for behavioral addictions are nalmefene and naltrexone. Psychological treatment options include motivational interviewing and cognitive behavioral therapy. Social treatment options include 12-step groups and sober companions

In a related lecture by Dr. Akiva M Daum, addiction and abuse of novel psychoactive substances was the topic. Dr. Daum addressed novel psychoactive substances (NPS) and discussed how dangerous these substances can be, including risk of different durations of action, varying potentials for abuse, and toxic side effects such as: excited delirium, agitation and violence, psychosis, and death. Forensic Toxicologist, Donna Papsun discussed the difficulty in detecting the chemical composition of synthetic drugs in the laboratory and compared the accuracy of different methodologies. She also discussed the challenge of the time delay between NPS appearance on the market and availability of testing. Dr. Castellanos presented examples of interventions that have been implemented to control the outbreaks of NPS. Dr. Haddad presented data on fentanyl seizures, overdoses, and related deaths.

Interview with Nora Volkow, Director of National Institute on Drug Abuse

The Neuroscience Education Institute had the pleasure of interviewing the Director of the National Institute on Drug Abuse (NIDA), Dr. Nora Volkow. The full interview can be found by subscribing to the NEI Podcast.

A partial transcript of the interview is listed below:

NEI: “What are some of the most common misconceptions that exist in the public, as well as by clinicians in terms of opioid addiction?”

Dr. Volkow: “Well, I’ll say that a very common misconception that has contributed to many of the problems that we see is that the physicians believe that if a patient has pain they will not become addicted to their pain medication, and that’s actually not correct. We know that 8% of individuals prescribed opioids properly will become addicted to their medications, and a significantly higher number, 24%-30% may misuse those medications. The other very frequent misconception among clinicians is equating physical dependence to addiction. Physical dependence reflects the changes in the body, not just in the brain that result in withdrawal symptoms, and these develop very, very rapidly. So if you are giving an opioid to somebody and then you interrupt it, that person can go into withdrawal, and many physicians equate that with addiction. Addiction, on the other hand, actually leads to changes in the way that the brain functions, in such a way that the person loses their capacity for self-revelation and control and develops a very, very strong urgency and desire for the drug, which is exactly the two things you don’t want. It’s the extreme desire for the drug and the incapacity to control it that leads to the escalation of drug consumption and the use of the drug even though you no longer want to do it. So that’s what addiction is. It takes much longer to develop a physical dependence, but unfortunately whereas with physical dependence you recover after a few days of withdrawal, in the case of addiction, the changes in the brain last months, sometimes years and require chronic treatment.”

For more on the 2017 APA, see our Highlights post.