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Published: 19 July 2024

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Nicotine, arguably the most difficult of substance use habits to ‘kick’, is highlighted in the following research, but one can apply this same ‘non-assisted’ exiting of drug use to other substances to. 

This of course is and has been done by millions of citizens who through abstinence based programs and processes, including therapeutic communities and 12 Step programs, has seen people break free from the tyranny of addiction. 

This exhortation, if you will, is not to denigrate medically assisted treatments that help an individual exit the drug using habits that are undermining their health and humanity – No, not at all!  It is, however, wanting to put back in a more prominent place on the ‘treatment table’ that has been cluttered with a growing number of drug use maintenance vehicles masquerading as treatment options, and empower people to become the drug free human units they were born to be. 

Also see ‘Drug Use, Stigma and Proactive Contagions to Reduce Both’

The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences

Summary Points

• Research shows that two-thirds to three-quarters of ex-smokers stop unaided. In contrast, the increasing medicalisation of smoking cessation implies that cessation need be pharmacologically or professionally mediated.
• Most published papers of smoking cessation interventions are studies or reviews of assisted cessation; very few describe the cessation impact of policies or campaigns in which cessation is not assisted at the individual level.
• Many assisted cessation studies, but few if any unassisted cessation studies, are funded by pharmaceutical companies manufacturing cessation products.
• Health authorities should emphasise the positive message that the most successful method used by most ex-smokers is unassisted cessation.

Introduction

As with problem drinking, gambling, and narcotics use [1]–[9] population studies show consistently that a large majority of smokers who permanently stop smoking do so without any form of assistance [10]–[15]. In 2003, some 20 years after the introduction of cessation pharmacotherapies, smokers trying to stop unaided in the past year were twice as numerous as those using pharmacotherapies and only 8.8% of US quit attempters used a behavioural treatment [16]. Moreover, despite the pharmaceutical industry's efforts to promote pharmacologically mediated cessation and numerous clinical trials demonstrating the efficacy of pharmacotherapy, the most common method used by most people who have successfully stopped smoking remains unassisted cessation (cold turkey or reducing before quitting [16],[17]). In 1986, the American Cancer Society reported that: “Over 90% of the estimated 37 million people who have stopped smoking in this country since the Surgeon General's first report linking smoking to cancer have done so unaided.” [18]. Today, unassisted cessation continues to lead the next most successful method (nicotine replacement therapy [NRT]) by a wide margin [15],[16].

Yet, paradoxically, the tobacco control community treats this information as if it was somehow irresponsible or subversive and ignores the potential policy implications of studying self-quitters. Unassisted cessation is seldom emphasised in advice to smokers [19]. We know of no campaigns that highlight the fact that most ex-smokers quit unaided even though hundreds of millions have done just that. Reviews typically give unassisted cessation cursory attention [20], framing it as a challenge to be eroded by persuading more smokers to use pharmacotherapies: “Unfortunately, most smokers …fail to use evidence-based treatments to support their quit attempts” [21]; “If there is a major failing in the UK approach, it is not that it has medicalised smoking, but that it has not done so enough.” [22]. Clinical guidelines also ignore unassisted cessation [8]. Finally, although the US National Centre for Health Statistics routinely included a question on “cold turkey” cessation in its surveys between 1983 and 2000, this question disappeared in 2005 [23].

Because of these prevalent attitudes, smoking cessation is becoming increasingly pathologised, a development that risks distortion of public awareness of how most smokers quit to the obvious benefit of pharmaceutical companies. Furthermore, the cessation research literature is preoccupied with the difficulty of stopping. Notably, however, in the rare literature that has bothered to ask [24], many ex-smokers recall stopping as less traumatic than anticipated. For example, in a large British study of ex-smokers in the 1980s, before the advent of pharmacotherapy, 53% of the ex-smokers said that it was “not at all difficult” to stop, 27% said it was “fairly difficult”, and the remainder found it very difficult

(For complete research go to PLOS Medicine)

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Published: 19 July 2024

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The intricate relationship between myelination in the brain and addiction to opioids has been a subject of recent research conducted by scientists at Stanford Medicine. This groundbreaking study sheds light on how adaptive myelination, a process crucial for learning new skills, can also play a role in promoting addiction to opioids. By unravelling the mechanisms underlying this phenomenon, researchers aim to deepen our understanding of addiction pathways and potentially pave the way for innovative approaches to addressing substance use disorders.

Myelination and Learning

• Myelin, the fatty substance that forms around nerve fibres, is essential for efficient neural communication and cognitive functions. The process of myelination is intricately linked to learning and acquiring new skills, as it enhances the speed and precision of signal transmission within the brain. This study suggests that the same mechanism responsible for learning may contribute to the development of addiction under certain circumstances.
• Opioid addiction poses a complex challenge, impacting individuals at both physiological and psychological levels. By exploring how adaptive myelination influences the brain’s response to opioid exposure, researchers seek to uncover the neural pathways involved in addiction development. Understanding these pathways is crucial for designing targeted interventions that address the root causes of substance dependence.

Neuroplasticity and Addiction

• Neuroplasticity, the brain’s ability to reorganise itself in response to experiences, plays a significant role in addiction vulnerability. The study’s findings suggest that changes in myelination patterns associated with opioid use may alter neural circuits related to reward processing and decision-making, contributing to the reinforcement of addictive behaviours over time.
• Insights from this research hold promise for informing novel treatment strategies for opioid addiction. By identifying the impact of myelination on addiction pathways, clinicians and researchers may develop tailored interventions that target specific neural mechanisms involved in substance use disorders. This personalised approach could lead to more effective and sustainable treatments for individuals struggling with opioid addiction.

(Source: Stanford Medicine also see RESILIENT BRAIN – RESILENT LIFE)

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Published: 19 July 2024

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The intersection of neuroscience and addiction treatment has paved the way for innovative interventions aimed at addressing cognitive alterations that can hinder the effectiveness of current treatments for substance use disorders. The study published on Wiley Online Library presents a comprehensive overview of expert-endorsed cognitive rehabilitation interventions, such as cognitive bias modification, contingency management, cognitive remediation, and emotion regulation training, as adjuncts to traditional substance use disorder treatments. Here, we delve into the therapeutic mechanisms, clinical implications, and translation challenges associated with these interventions:

Cognitive Bias Modification

By resetting drug-related biases through various forms of computerised cognitive training, cognitive bias modification aims to redirect tendencies towards substance use to alternative targets. This intervention targets addiction-related alterations in the incentive salience system, diminishing the value of drug rewards while enhancing the value of alternative reinforcers.

Contingency Management

Contingency management offers tangible incentives, like monetary payments, for achieving therapeutic goals such as treatment attendance or abstaining from substance use. By reducing the value of drug rewards and increasing the value of non-substance-related reinforcers, this intervention addresses addiction-related alterations in the incentive salience system.

Through mental strategies designed to restore cognitive deficits and enhance everyday functioning, cognitive remediation focuses on improving cognitive skills to support adaptive behaviour. Strategies like “pause – check your goal – choose” help individuals thwart impulsive decisions in high-risk scenarios, thereby strengthening executive control of behaviour.

Emotion Regulation Training

Emotion regulation training utilises mental strategies to manage negative emotions and amplify positive affect, fostering improved emotional control and enhancing well-being. By targeting addiction-related alterations in the executive control system, this intervention strengthens top-down control over behaviour and emotions.

The Delphi consensus endorsed applying these interventions post-acute detoxification, maintaining them weekly for at least three months. Individualised neuropsychosocial assessments guide the selection of specific interventions tailored to each individual’s needs and substance use disorder profile.

Despite the evidence-informed nature of these interventions, their translation into clinical practice faces several barriers. Controversies around addiction models, the gap between research and clinical realms, limited technology and resource availability, and complex policy landscapes present hurdles to integrating cognitive rehabilitation into addiction treatment.

(Source: Wiley Online Library)

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Published: 08 July 2024

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Managing pain when struggling with addiction presents a complex challenge that requires a delicate balance between pain relief and addiction management. Individuals grappling with addiction face unique hurdles when it comes to pain management, as traditional pain medications may pose a risk of triggering or exacerbating addictive behaviours. Integrative approaches that combine non-pharmacological methods, such as physical therapy, acupuncture, mindfulness techniques, and cognitive-behavioural therapy, alongside non-addictive pharmacological options, offer a holistic approach to pain relief while minimising the risk of addiction relapse.

Navigating the intersection of pain management and addiction recovery necessitates a tailored treatment plan that addresses both physical discomfort and psychological aspects of addiction. Engaging in open communication with healthcare providers, addiction specialists, and pain management professionals is crucial to crafting a personalised pain management strategy that prioritises both pain control and addiction recovery goals. By adopting a comprehensive and collaborative approach, individuals can effectively manage pain while safeguarding their progress in addiction treatment.

(WRD News)