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Published online 25 June 2009 | Nature | doi:10.1038/news.2009.600
News: Q&A
A helping hand for addicts
A neuropsychologist talks about the challenges of studying the addicted brain.
Vincent Clark, of the University of New Mexico in Albuquerque, thinks he has something like a crystal ball for drug addicts. By applying traditional psychiatric evaluation and modern fMRI brain imaging to people recovering from drug addiction, he claims to be able to spot who is likely to relapse — months before the relapse actually happens.
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Yes, this is very interesting research to locate the relapse. More finding is required to stop signalling in the brain that urges for drugs. Thanking You
This research is long overdue. We tend to lump all addicts together as if they had the same disease. You might want to look at some of NIDA's large databases along with the annual health surveys conducted by the government. Every year, about 12.5% (1/8) of the addicts being followed will drop of the demographics that characterize a severe addict - use of e.r facilities, welfare, SSDI, etc. Several years ago, I studied a population of heroin and stimulant addicts who had at least 25 year histories of treatment, with no evidence of success. Using computerize EEG mapping, in addition to CT scans and MRI?s, we found that about 70% had a temporal lobe focus, and of those many were selective clonazepam seekers, who claimed that the drug made them "normal," with no reports of enhanced euphoria from combining clonazepam with methadone. The most severely impaired also had positive first degree family histories of panic disorder. In addition to clonazepam, these also sought alprazolam. When their self-selected regimes were stabilized and they were closely monitored for compliance, every one of these patients eventually "lost interest" in methadone and underwent very slow but successful withdrawal. We also screened for platelet monoamine oxidase activity. Those with low activity had affective and addictive cycles, just like a true bipolar. And, those with elevated MAO levels were usually diagnosed as "borderlines." They responded to MAOIs in addition to the drugs used for withdrawal. It seems to me that we must give up the notion of finding a magic spot that controls addictive behavior. We need to build up a multidimensional diagnostic picture of every relapsing addict. Not just an MRI, and CTscan or map, but neuropsychiatric testing and careful blood level monitoring throughout treatment. If patients are made partners in their own treatment, there is no reason to discharge a patient who relapses. Even with so called sociopathic patients, the most likely cause of a relapse is the failure to recognize and treat effectively an intrusive symptom, and not some fable about the patient's lack of motivation. The time frame to stabilize a severely impaired addict should be measured in months or years. We have to treat each individual symptom with the most effective and least dangerous drug treatment available, until we have built up an effective chemical holding pattern for the brain to begin building reparative pathways around the damaged or malfunctioning areas. Good luck!