Relapse Prevention: Perspectives of a Researcher and a Crusader
By Rita Watson, MPH
October 25, 2011: Drug addiction is once again in the news from studies in Vancouver for addicts to 'SNL's' Darrell Hammond Revealing his Addiction to relapse prevention at Yale to a website devoted to helping those who wish find a way to get the help they need using the same tool kits. Presented here are two perspectives, one from Dr. Rajita Sinha of Yale School of Medicine who is Foundations Fund Professor of Psychiatry, Neurobiology and Child Study, Chief, Psychology Section in Psychiatry and Director of the Yale Stress Clinic (www.yalestress.org) and Timothy Cheney, who, with colleague Adrian S. Hooper, Jr., founded www.ChoopersGuide.com, a unique resource for those seeking help.
The perspective from Yale
First off, the problem. According to Dr. Sinha “stress increasing drug craving and anxiety and both are predictive or how quickly someone relapses. The biological stress response is disrupted in addicted individuals during early recovery and this hampers the ability to regulate emotions and stress. This includes stress hormones such as cortisol and other nerve growth factors and changes in brain structure and responses to emotion and stress.
“More importantly, brain frontal regions involved in regulating stress and desires and controlling impulses are blunted so heightened desire and emotions cannot be regulated easily,” she said.
In essence Dr. Sinha’s research indicates that with new techniques, including brain imaging, it will be possible to determine those addicts who are unresponsive to treatment thereby targeting that population with specific interventions.
The cause for optimism – the ability to determine high relapse risk
Dr. Sinha pointed out: “We now have several brain and physiological measures that can be developed as biomarkers to assess who is at most risk of relapse when entering treatment. This will help provide more individualized treatment and tailor treatments based on the brain and biological impact of addiction on the person so as to improve recovery rates.
“Given that stress-induced drug craving and stress biology are playing a key role in relapse and to jeopardize recovery, the data are showing that stress related biology needs specific target in treatment. “
Medications are one of the promising treatments that are being developed to target the stress pathways such as stress reactivity and regulation. Some examples are Corticotropin-releasing factor (CRF) antagonists, as well as agents that decrease the effects of norepinephrine in the brain.
Biomarkers and behavioral treatments
Additionally said Dr. Sinha, “We now have several brain and physiological measures that can be developed as biomarkers to assess who is at most risk of relapse when entering treatment. This will help provide more individualized treatment and tailor treatments based on the brain and biological impact of addiction on the person so as to improve recovery rates, “ said Dr. Sinha.
She also noted that the data are showing that stress-related biology can be used to develop specifically targeted treatment approaches.
Dr. Sinha pointed out that behavioral treatments such as mindfulness strategies may also play a role in improvements with regard to relapse risk.
According to ChoopersGuide, a leading resource for addiction treatment, the primary mission is “to help the still suffering addicts and alcoholics find addiction treatment and recovery before they die.”
After a casual discussion on the state of the information industry in the treatment and recovery field Cheney and Hooper teamed up to create a 70,000 plus page website with over 31,000 provider listings.
Cheney said: “Over the past thirty years, the landscape has changed dramatically in the field of addiction treatment. We at Choopers Guide are excited by the advances in neurobiology and genetics and the potential that this new knowledge and technology promises in diagnosing and treating addiction disorders.
“Our vision is that as science continues to provide empirical data documenting addiction as a ‘brain disorder’, addiction will cease to be viewed as volitional act of moral misconduct, the stigma associated with addiction will recede. Once this happens persons afflicted with this disorder will be diagnosed, treated and reintegrated into society,” said Cheney.
Social and economic implications
Cheney added: “The social and economic implications are staggering. Currently, the United States has the distinct honor of housing 2.4 million prisoners which is 25% of the world’s prison population. It is estimated that 85% of this population has a substance abuse problem with 65% meeting the DSM –IV diagnostic criteria.
“Our goal,” added Cheney, “is to provide a resource that will further aid in reducing recidivism and ultimately save lives by making treatment information readily accessible.”