Friday, March 4, 2016

Science and Addiction: How We Can Use Science to Improve Success Rates in Rehabilitation


Smoking cigarettes starts out as a pleasurable habit, that quickly turns into an all-consuming addiction. However, reversing the habit and quitting smoking does not happen quickly, or sometimes doesn't happen at all. In fact, without the help of therapy or medicine only about 4% to 7% of people are able to quit smoking, and the number rises to about 25% for people who reach out for medicinal and therapeutic help. Many people fail in their attempt to  unclench the steel grip of addiction, and although they, and the people around them, most often blame the failure on lack of self will there is evidence that shows that addiction to nicotine has a biological reason. 


According to the research article "Nicotine Potentiation of Excitatory Inputs to Venral Tegmental Area Dopamine Neurons", published by Daniel McGehee and his team at University of Chicago, nicotine, the main addictive substance in cigarettes and tobacco, causes adaptive changes at the cellular level of the brain through activation of nicotinic receptors. After the activation of these receptors a strong preference was found for appetitive behaviors and addictions in synaptic strength. Nicotine was proven to induce long-term potentiation in the ventral tegmental area dopamine neurons by increasing glutamate release on glutamate terminals, which contributed to the induction of synaptic plasticity. This showed the the importance of the presynaptic strength that is brought on by the effects of nicotine. In addition, McGehee showed that in vivo exposure of nicotine to brain slices from drug-naïve rats also induced excitatory synaptic plasticity. 

The data collected by McGehhe showed incredible similarity between nicotine and cocaine in the mechanisms underlying synaptic plasticity in the ventral tegmental area, and it suggested that the changes in brain function are what cause such strong addiction and need for cigarettes. Yet, although these scientific findings have been brought to light, it seems that they are not currently being used to help treat addiction. Gabrielle Glaser, author of the article "Rehab Rooted in Science", explains that rehabilitation programs still mostly rely on the 12-step doctrine of 80-year-old Alcoholics Anonymous and Narcotics Anonymous. Addicts are told that they have a "moral and spiritual defect" and must give themselves to a higher power in order to escape addiction. Treatment like this is usually delivered through group therapy led by counselors who's qualifications might be minimal. In fact, in some states drug counselors can treat addicts with only a high school degree.

Glaser goes on to describe Dr. Mark Willenbring, the owner of an out-patient rehabilitation facility with a different approach to treating patients. He explains the neuroscience of alcohol and drug dependence and relieves the patients with the idea that their previous failures of quitting were caused by more than a lack of will. He has repeated this talk hundreds of times, and while it is scientifically irrefutable, it is not what addicts usually hear at rehabilitation centers. Dr.Willenbring thinks that most approaches used now ignore the most recent scientific research, with most traditional centers failing to take advantage of the findings. His treatment plans work with the findings of dozens of studies proving the efficacy of medication and behavioral therapies, and can involve medication to reduce cravings, block the highs of narcotics, and prevent relapse. Instead of using spiritual confession,  he uses a test of behavioral therapies to identify the triggers in patients and help them understand why they drink or use drugs. Additionally, he treats his patients for depression, anxiety, A.D.H.D., chronic pain, and post-traumatic stress disorder, all of which can make recovery for addicts very difficult.

Dr.Willenbring's work is a new way of thinking about and treating addiction, and it works along with scientific findings, such as those of Daniel McGehee, to help make recovery easier and more successful for addicts. The science helps us understand addiction  better by uncovering what changes happen in the brain, such as the long-term potentiation of dopamine neurons and the synaptic plasticity caused by the use of nicotine. Dr. Willenbring is adamant that along with behavioral therapies, drugs and medications are vital for a safe recovery. With the rise of treatment centers like this, that listen to the scientific findings, rehabilitation can be made easier, safer, and more successful for addicts.

Works Cited
"A Word about Success Rates for Quitting Smoking." A Word about Success Rates for Quitting Smoking. American Cancer Society, n.d. Web. 25 Feb. 2016.

Glaser, Gabrielle. "For Mark Willenbring, Substance Abuse Treatment Begins With Research." The New York Times. The New York Times, 22 Feb. 2016. Web. 25 Feb. 2016.

Mao, D., K. Gallagher, and D. S. Mcgehee. "Nicotine Potentiation of Excitatory Inputs to Ventral Tegmental Area Dopamine Neurons."Journal of Neuroscience 31.18 (2011): 6710-720. Web. 26 Feb. 2016.

Pictures
"Home Page - The Cigarette Whisperer." The Cigarette Whisperer. Cigarette Whisperer, n.d. Web. 04 Mar. 2016.

"What Happens 20 Minutes After You Quit Smoking: A Timeline of How Your Body Heals." Spirit Science. Health Sector, 29 Sept. 2015. Web. 04 Mar. 2016.

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