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PubMed2002

[Bariatric surgery -- stereotypes and paradigms].

Many physicians regard obesity as a sin and treat fat patients with disdain befitting a moral leper. Non-bariatric physicians, being a product of our culture, seem more likely to have an obesity paradigm close to that of the public. Many members of the public regard obesity surgery as dangerous. Many insurers reject morbid obese patients from bariatric surgical treatment with the paradigmal statement that obesity is totally the fault of a fat person. These medical experts do not accept obesity as a disease (which WHO does) and therefore social courts also reject applications of patients who want to undergo bariatric surgery. Morbid obesity is a multifactorial problem with genetic, biochemical, hormonal, environmental, behavioral and cultural elements. It is recognized as an extreme health hazard which is rarely the result of an aberrant moral problem or true addictive behavior. We need to change effectively the negative paradigms towards obesity and its surgery from some of our colleagues, hospital administration, medical insurers and the public. The existing prejudices are not acceptable.

Attitude of Health Personnel↗

PubMed1990

Conditioning as a critical determinant of sensitization induced by psychomotor stimulants.

It is apparent that stimuli associated with psychomotor stimulants as well as opiates acquire the ability to elicit motor behaviors that probably reflect the acquisition and operation of incentive motivational processes. Such conditioning also appears to be a critical determinant of behavioral sensitization seen with repetitive administration of these agents. The conditioning of motor excitation to stimuli associated with psychomotor stimulants follows the principles of classical conditioning and is relatively long lasting. Dopaminergic mechanisms appear to be involved in the acquisition of such conditioned behaviors, since neuroleptics are effective blockers of the process. Dopaminergic blockade probably disrupts conditioning through several different mechanisms including attenuation of the conditioned and unconditioned excitatory properties of the CS and blockade of the US. DA blockade prevents stimuli associated with psychomotor stimulants from acquiring and subsequently generating positive affective motivational states that are reflected by increases in motoric output. While dopamine appears to be necessary for the formation of conditioned motor excitation, it is not critically involved in the expression of the conditioned effects. This seems to suggest that DA may serve only to modulate the formation of motivationally significant associations but is not involved in the expression of conditioned drug effects that may be mediated through DA-independent pathways. The amygdala and nucleus accumbens are two structures in the CNS involved in the acquisition of conditioned motor excitation. Interestingly, both of these brain regions are the recipients of mesolimbic DA input. Dopamine probably plays different roles in each region during the conditioning process. In the amygdala, mesolimbic DA may serve to modulate processes that attach emotional significance to environmental stimuli; further, DA may play a role in determining which stimuli gain access to structures afferent to the amygdala, including the nucleus accumbens. Dopamine in the nucleus accumbens, on the other hand, serves to determine which limbic inputs gain access to the motor pathways. In this way, DA in the nucleus accumbens may translate the motivational determinants of behavior that are mediated by limbic structures into biologically relevant actions. Understanding the mechanisms that determine the conditioning of drug effects to associated stimuli also has possible relevance for elucidating processes underlying addictive behaviors. For example, it has been proposed (Stewart et al. 1984) that the acquisition of incentive motivational properties by stimuli associated with drugs determines the craving in addicts.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

PubMed1980

Family ties of heroin addicts.

Families of black, male heroin addicts of low socioeconomic class were compared with families of schizophrenics and high-achieving normal controls. The hypothesis was that heroin addicts are enmeshed with their parents or parental surrogates in alliances across generational lines and in reversals of the hierarchical organization of their families that, clinically, appear to perpetuate the addictive behavior. Family members chose representations of their hiertarchical relations to show closeness and distance between family members. There were significant differences among the three groups. Heroin addicts' families had the highest number of representations in which offspring were equal to or higher in the hierarchy than the parental generation and in which closeness was represented between two family members across generational lines. High achievers' families had the lowest scores; schizophrenics' families were in the middle. The results support clinical observations of heroin addicts' families and offer a guide for therapy.

Adolescent↗

PubMedDate not supplied

Counseling strategies for obese patients.

Counseling strategies usually assume that an individual is ready to change; however this assumption is probably not true for many obese individuals seeking medical care. Since individuals progress through a series of stages of change, some may not yet be ready to change. The transtheoretical model of behavior change proposes that individuals move through stages of change: precontemplation, contemplation, preparation, action, and maintenance. This model has been successfully applied to a range of addictive behaviors. The application of the transtheoretical model of behavior change to obesity treatment holds promise because interventions that match treatment strategies to an individual's stage of change may be more effective than current treatments. This article reviews the potential benefits of using the transtheoretical model for weight management in the primary care setting. Medical Subject Headings (MeSH): obesity, counseling, behavior.

Adaptation, Psychological↗

PubMed1990

Nonprogressing profiles in smoking cessation: what keeps people refractory to self-change?

A 2-year cross-sequential analysis of informal self-change efforts at smoking cessation evaluated the use of coping operations and the mediation of cognitive judgments among four composite profiles. Subjects (N = 544) were grouped by stage of readiness to change (contemplation, action, relapse, and maintenance) and assessed every 6 months on 10 change processes, self-efficacy, and the decisional balance between the "pros" and "cons" of smoking. Two change status profiles, contemplation to maintenance, and relapse to maintenance, were selected as exemplars of optimal linear progress; two others, chronic contemplation and chronic relapse, illustrated nonprogressing patterns in which subjects remained stuck in the same stage for 2 years. Multivariate and univariate ANOVA results indicated that nonprogressing smokers overutilize certain experiential change processes rather than underutilizing behavioral strategies, as was predicted. Implications of these results for specialized self-help interventions are discussed in the context of a comprehensive model of change for the addictive behaviors.

Adult↗

PubMed2004

Direct interactions between the basolateral amygdala and nucleus accumbens core underlie cocaine-seeking behavior by rats.

An insidious feature of drug craving and drug seeking in humans is that it can be induced and maintained by conditioned stimuli after a prolonged drug-free period. Understanding the neural basis of this control over addictive behavior may aid in the development of treatments targeting drug seeking and thereby be beneficial in preventing drug use. In the present study, we used a well established animal model to investigate the functional importance of amygdala-nucleus accumbens interactions in cocaine seeking under the control of drug-associated conditioned reinforcers. To probe the direct neuroanatomical relationship between these structures within a functional corticostriatal loop, we used a neuropharmacological disconnection procedure. Thus, infusing a dopamine receptor antagonist unilaterally into the basolateral amygdala (which had no effect on its own) and an AMPA-kainate (KA) receptor antagonist into the contralateral nucleus accumbens core (which also had no effect on its own) greatly reduced cocaine seeking. We also show that bilateral infusions of the DA receptor antagonist into the amygdala, but not nucleus accumbens, or of the AMPA-KA receptor antagonist in the nucleus accumbens, but not the amygdala, also greatly reduced cocaine seeking. The results of this study demonstrate an amygdala-nucleus accumbens system that critically underlies stimulus-controlled cocaine seeking and indicate possible neurochemical targets for relapse-prevention medication.

Amygdala↗

PubMedDate not supplied

Extinction training regulates neuroadaptive responses to withdrawal from chronic cocaine self-administration.

Cocaine produces multiple neuroadaptations with chronic repeated use. Many of these neuroadaptations can be reversed or normalized by extinction training during withdrawal from chronic cocaine self-administration in rats. This article reviews our past and present studies on extinction-induced modulation of the neuroadaptive response to chronic cocaine in the mesolimbic dopamine system, and the role of this modulation in addictive behavior in rats. Extinction training normalizes tyrosine hydroxylase levels in the nucleus accumbens (NAc) shell, an effect that could help ameliorate dysphoria and depression associated with withdrawal from chronic cocaine use. Extinction training also increases levels of GluR1 and GluR2/3 AMPA receptor subunits, while normalizing deficits in NR1 NMDA receptor subunits, in a manner consistent with long-term potentiation of excitatory synapses in the NAc shell. Our results suggest that extinction-induced increases in AMPA and NMDA receptors may restore deficits in cortico-accumbal neurotransmission in the NAc shell and facilitate inhibitory control over cocaine-seeking behavior. Other changes identified by gene expression profiling, including up-regulation in the AMPA receptor aggregating protein Narp, suggest that extinction training induces extensive synaptic reorganization. These studies highlight potential benefits for extinction training procedures in the treatment of drug addiction.

Adaptation, Physiological↗

PubMed1989

Prolonged morphine self-administration and addiction liability. Evaluation of two theories in a bone marrow transplant unit.

The technology for patient intravenous self-administration of morphine has been successfully implemented in postoperative and other clinical settings and can be used with terminal patients who experience pain. The question of whether patients who use such instrumentation will be vulnerable to over-medication or development of addiction has not been addressed. This report reviews two competing theories that bear upon this question and tests their predictions about self-administration of morphine for pain relief using data obtained from patients in a bone marrow transplant unit. The first, Opponent Process Theory, predicts escalating drug use and the development of addictive behavior in patients who self-administer morphine. The second, Control Theory, predicts that patients will self-regulate pain effectively by administering morphine without developing problems of medication abuse or addiction. Patients self-administering morphine for 2 weeks were compared to controls who received the drug via routine staff-controlled continuous infusion procedures. Self-administering patients used significantly less morphine than controls and still achieved the same amount of pain control; moreover, they terminated drug use sooner than controls. The predictions based upon Opponent Process Theory were not supported in these marrow transplant patients, but Control Theory accounted well for the outcomes. These results support the assumption that self-administration of opioids in a medical setting does not put patients at risk for over-medication or addiction.

Adult↗

PubMed1982

The addictive process.

In order to understand and treat addictions one must go beyond the specific agent and practice, one must understand the addictive process. The author bases his conceptualization of an addictive process on twenty-five years of naturalistic observation, individual and group psychoanalytic psychotherapeutic treatment and therapeutic trials of one hundred and thirty-three single and poly substance and behavior addicted patients. No single addictive personality (addict) exists. People become addictive because specific etiological and constitutional factors contribute to their vulnerability to the addictive process. This process can be defined and diagnosed. It involved common inter/intrapersonal psychodynamics. One must look for the addictive complement and trigger mechanisms which can initiate and perpetuate the process. The process has a life history and stages, which can be cyclic, periodic, or sporadic. The individual can shift from one addiction to another or sustain multiple addictions at different times. Understanding the above factors is essential to making an accurate diagnosis and to treatment.

Ego↗

PubMedDate not supplied

[Problems of diagnosis and classification related to the improper use of substances in the DSM-III and DSM-III-R].

This paper attempts at reviewing the changes DSM-III-R introduced in the chapter DSM-III devoted to substance-induced disorders. The respective advantages, and disadvantages of the new concepts are studied. Among the new concepts, the author ponders on the discrimination between Abuse, and Dependence--in DSM-III--being deleted while Dependence alone is now enlarged so that such a modification brings us back to the idea of "dependency" through a listing of addictive behaviors--valid for any type of substance--whose intensity is evaluated by means of the number, and severity of behaviors involved. It is the author's opinion that such an analysis may prove to be a necessary starting point for future in-depth studies on the difficult topic of addictive subtypology.

Mental Disorders↗

PubMed2005

Alcohol dependence and gene x environment interaction in emotion regulation: Is serotonin the link?

Alcohol dependence is characterized by frequent, compulsive and uncontrolled consumption of alcohol associated with behavior of maladaption and destruction. It is an etiologically and clinically heterogeneous syndrome, moderately to highly heritable, and caused by interaction of genes and environment. Alcohol dependence is related to other psychiatric diseases by common neurobiological pathways, including those that modulate reward, behavioral control as well as anxiety and stress response. Alcohol induces adaptive changes in brain function providing the basis for tolerance, craving, withdrawal, and emotional disturbance. The differentiation of psychobiological traits of addictive behavior reflecting neurobiological processes is therefore of particular importance for the dissection of the complex genetic susceptibility to alcohol dependence. A central serotonin (5-HT) deficit is thought to be involved in the pathogenesis of alcohol dependence by modulating motivational behavior, neuroadaptive processes, and resulting emotional disturbance. 5-HT-related impulsive, aggressive, and suicidal behavior has been linked to a primordial personality that is susceptible to alcohol dependence. Although variations in many of the genes that encode receptors, enzymes, and transporters of the 5-HT system have been tested as risk factors for alcohol dependence, genetic analyses of 5-HT signaling in alcohol dependence have mainly been focused on the 5-HT transporter (5-HTT) gene. Due to its central role in the fine-tuning serotonergic neurotransmission, a regulatory variant of the 5-HTT, which is associated with anxiety related traits, is not only a key player in the neurobiological mechanism of gene x environment interaction in the etiology of depression, but also contributes to the risk to develop alcohol dependence with antisocial behavior and suicidality. Evidence for a modulatory effect of allelic variation of 5-HTT function on limbic circuit responses to emotional stimuli suggests that genotype-endophenotype correlations may be accessible to molecular functional imaging of the brain. These new developments have broad implications for our understanding how genetic vulnerability to alcohol dependence is manifested in the brain's response to emotional stimuli.

Alcoholism↗

PubMed2006

Opiates, psychostimulants, and adult hippocampal neurogenesis: Insights for addiction and stem cell biology.

Once thought to produce global, nonspecific brain injury, drugs of abuse are now known to produce selective neuro-adaptations in particular brain regions. These neuro-adaptations are being closely examined for clues to the development, maintenance, and treatment of addiction. The hippocampus is an area of particular interest, as it is central to many aspects of the addictive process, including relapse to drug taking. A recently appreciated hippocampal neuro-adaptation produced by drugs as diverse as opiates and psychostimulants is decreased neurogenesis in the sub-granular zone (SGZ). While the role of adult-generated neurons is not clear, their functional integration into hippocampal circuitry raises the possibility that decreased adult SGZ neurogenesis may alter hippocampal function in such a way as to maintain addictive behavior or contribute to relapse. Here, we review the impact of opiates and psychostimulants on the different stages of cell development in the adult brain, as well as the different stages of the addictive process. We discuss how examination of drug-induced alterations of adult neurogenesis advances our understanding of the complex mechanisms by which opiates and psychostimulants affect brain function while also opening avenues for novel ways of assessing the functional role of adult-generated neurons. In addition, we highlight key discrepancies in the field and underscore the necessity to move "beyond BrdU"--beyond merely counting new hippocampal cells labeled with the S phase marker bromodeoxyuridine--so as to probe mechanistic questions about how drug-induced alterations in adult hippocampal neurogenesis occur and what the functional ramifications of alterations in neurogenesis are for addiction.

Animals↗

PubMed2004

Alexithymia, depressive experiences, and dependency in addictive disorders.

Alexithymia, depressive feelings, and dependency are interrelated dimensions that are considered potential "risk factors" for addictive disorders. The aim of this study was to investigate the relationships between these dimensions and to define a comprehensive model of addiction in a large sample of addicted subjects, whether affected by an eating disorder or presenting an alcohol- or a drug use-related disorder. The participants in this study were gathered from a multicenter collaborative study on addictive behaviors conducted in several psychiatric departments in France, Switzerland, and Belgium between January 1995 and March 1999. The clinical sample was composed of 564 patients (149 anorexics, 84 bulimics, 208 alcoholics, 123 drug addicts) of both genders with a mean age of 27.3 +/- 8 years. A path analysis was conducted on the 564 dependent patients and 518 matched controls using the scores of the Toronto Alexithymia Scale, the Depressive Experiences Questionnaire, and the Interpersonal Dependency Inventory. Statistical analyses showed good adjustment (Goodness of Fit Index = 0.977) between the observable data and the assumed model, thus supporting the hypothesis that a depressive dimension, whether anaclitic or self-critical, can facilitate the development of dependency in vulnerable alexithymic subjects. This result has interesting clinical implications because identifying specific patterns of relationships leading from alexithymia to dependency can provide clues to the development of targeted strategies for at-risk subjects.

Adolescent↗

PubMed1998

The use of opioid drugs in management of chronic orofacial pain.

The use of opioid analgesics for the management of patients with chronic pain is controversial. However, randomized and double-blind clinical trials have shown that in select groups of patients with chronic pain, the daily administration of oral opioids decreases pain levels and improves quality of life. This article provides a review of the most recent basic and clinical research supporting the rationale for the use of opioids in a select group of patients with chronic orofacial pain. Critical to the employment of this technique are proper patient evaluation and use of comprehensive management strategies. This management scheme should be reserved for patients with chronic pain that is refractory to most nonopioid therapy. The primary reason for the clinician's reluctance to initiate long-term opioid therapy for their patients with chronic pain is the potential risk of developing opioid tolerance, dependence, or addiction. In contrast to these beliefs, studies have shown a nonexistent to low risk of opioid dependence or addiction behavior with administration of scheduled oral opioids in chronic pain patients. It is essential that potential patients for this type of therapy have been carefully screened and have not had a history of drug addiction. The criteria to be evaluated when considering opioid therapy for chronic orofacial pain control include 1) inadequate pain diminution from prior nonopioid therapy, 2) negative history of substance abuse, 3) definitive determination that the pain being treated is of physiologic rather than psychologic origin, 4) a willingness to adhere to an "opioid contract" between the doctor and patient, 5) compliance with a scheduled, rather than "as needed" or "breakthrough," administration of an oral opioid, and 6) close clinical follow-up to evaluate pain relief, return to daily activities, and titration of drug levels. If these criteria are followed, administration of oral opioids may be a successful means of decreasing the patient's debilitating chronic pain to tolerable levels, enabling an improvement in the quality of life and return to function.

Analgesics, Opioid↗

PubMed2001

The D3 dopamine receptor and substance dependence.

Behavioral sensitization, the progressive and enduring enhancement of certain stimulant-induced behaviors following repetitive drug use, is mediated in part by dopaminergic pathways known to play a role in drug dependence. It has been theorized that sensitization underlies the development of drug craving and initiates addictive behaviors of drug dependence. We propose that down-regulation of D3 dopamine receptor function contributes to sensitization. Rodent locomotion is regulated by the opposing influence of dopamine receptor subtypes, with D3 stimulation inhibiting and concurrent D1/D2 receptor activation stimulating locomotion. The D3 receptor has greater occupancy than D1 or D2 receptors following stimulant drug administration. Sensitization may therefore result in part from greater accommodation of the inhibitory D3 receptor "brake" on locomotion, leading to progressive locomotion increase following repeated stimulant exposure. Further study is needed to test this proposed model, and to clarify the role of individual dopamine receptor subtypes in sensitization and drug dependence.

Animals↗

PubMed2005

Executive summary: nicotine addiction.

Nicotine addiction is one of the most prevalent addictive behaviors worldwide. According to the World Health Organization (WHO), 1.3 billion men, women and children worldwide are smokers. In spite of increased awareness and action on the part of both governments and individuals, tobacco continues to be the leading cause of preventable disease and death in the United States, as well as in many other countries. According to WHO, there are nearly 5 million tobacco-related deaths worldwide each year and nearly half of the smokers in the world today will die as a result of their addiction. For individuals who are motivated to quit smoking, a combination of pharmacotherapy and behavioral therapy has been shown to be most effective in controlling the symptoms of nicotine withdrawal. Drugs marketed as smoking cessation aids include nicotine replacement therapy (NRT) and sustained-release bupropion hydrochloride. New drugs in development are directed to targets including nicotinic acetylcholine receptors, cannabinoid receptors, dopamine receptors and opioid receptors. Several therapeutic vaccines are also in the pipeline.

Humans↗

PubMed1988

Noncompliant hemodialysis patients. A biopsychosocial approach.

Noncompliance to fluid restrictions is remarkably common and difficult to treat in hemodialysis patients. Psychosocial variables have not been convincingly demonstrated to correlate with fluid noncompliance. Fluid overloading tends to begin early in the course of dialysis treatments and remains remarkably stable over time. This maladaptive behavior on the part of so many dialysis patients could be promoted by abnormalities in the renin-aldosterone-angiotensin system or other abnormalities in the homeostatic mechanisms that regulate water metabolism. Hypotheses related to addictive behavior and milieu variables are also discussed. Recommendations include using a nonmoralistic approach, flexibility in dialysis schedules, and psychological intervention at the onset of dialysis.

Adult↗

PubMed2005

[Vitamin and tobacco smoking].

Nicotine addiction is one of the most prevalent addictive behaviors worldwide. According to World Health Organization (WHO), there are nearly 5 million tobacco- related deaths worldwide each year and nearly half of the smokers in the world today will die as a result of their addiction and the main cause will be the lung cancer. Some studies have suggested that intake of the carotenoids might reduce cancer risk. Unfortunately, supplementation with vitamins: beta-carotene alone or in combination with alpha-tocopherol or retinol increased risk of lung cancer incidence and mortality in cigarette smokers and individuals with occupational exposure to asbestos.

Carotenoids↗