JULY 1, 2005 | Addiction, whether from drugs, tobacco or alcohol, ruins lives and has a huge impact on rural communities in Arkansas. Yet, within a state battling demons like methamphetamine, there is a glimmer of hope. The University of Arkansas for Medical Sciences’ (UAMS) new Center for Addiction Research has begun clinical trials to unlock the mysteries of substance abuse.
“Our mission is to become one of the nation’s premier centers on addiction,” said Warren K. Bickel, Ph.D., the new center’s director and professor of psychiatry and behavioral sciences in the UAMS College of Medicine. Bickel said he sees the new center incorporating almost every field of study on the UAMS campus, and influencing how treatment for addiction is handled worldwide.
Bickel is a national authority on examining the underlying behavioral processes of drug dependence in humans and has conducted research that examines novel cost-effective ways to deliver treatment. He holds the Wilbur D. Mills Chair in Alcoholism and Drug Abuse Prevention at UAMS.
“The Center for Addiction Research will allow the UAMS Department of Psychiatry to increase its cutting-edge research that will provide the basis for future treatments for addiction and mental illness,” said G. Richard Smith, M.D., professor and chairman of the Department of Psychiatry and Behavioral Sciences in the UAMS College of Medicine.
Joining Bickel is Alison Oliveto, Ph.D., professor and vice chair for research in psychiatry and behavioral sciences in the UAMS College of Medicine as well as a senior scientist in the new center. Oliveto previously was on the research faculty at Yale where she served as scientific director of the Yale Medications Development Research Center. At Yale, she helped develop and test new medications for the treatment of substance abuse. She has an active research program that examines the behavioral and cognitive effects of designer, or club, drugs as well as medications to treat cocaine dependence.
One of Bickel’s projects, a continuation of studies he started at the University of Vermont in Burlington, involves computerized therapy for drug addicts. Bickel said that in today’s information age, people are more comfortable with computers, and he has found in previous studies that it works at least as well as regular meetings with a substance abuse counselor, and is more cost effective.
“Most communities don’t have many resources available for substance abuse. We are looking at ways to increase treatment availability, especially in rural states. By using information technology, we are able to extend the reach of programs and provide better access,” he said.
In the computer therapy study, participants will go to a clinic and be asked to provide a urine sample. They then will access a computer program using an identification card that contains their unique identification.
If they have used drugs recently, as indicated by the urine sample, the computer program will coach participants on ways to avoid drugs. If they are negative for drug use, the program takes them through 49 modules which improve skill development and problem solving techniques. The modules help participants interact with others and modify their behavior. Each module takes 20 to 40 minutes to complete.
The clinical trial has three parts: one group will have the computer-based treatment three days a week with a face-to-face counseling session every two weeks, the second group will have sessions with a counselor three days a week and a control group will have sessions with a case manager periodically, Bickel said.
“One of the challenges is that treatments are often laborious for drug addicts to adopt in the real world,” he said. Some of Bickel’s more prominent work has involved measuring how addicts discount the future. While people without addictions may plan an average of 4.7 years in the future, Bickel’s previous studies with heroin addicts show they typically plan for about nine days into the future.
“If you’re only worried about the next nine days, you’re not worried about sharing dirty needles,” he said. This behavior, which is seen in varying degrees in those addicted to drugs, alcohol and even tobacco, makes it difficult for treatment programs to take effect because the addict cannot comprehend making long-term goals to create a better life. One positive observation, Bickel said, is that the further a person progresses from their addiction, the more they begin planning for the future like a person without an addiction.
To study the actual areas of the brain that correlate with discounting the future, Bickel has teamed with Diana Lindquist, assistant professor of radiology in the UAMS College of Medicine, to use brain imaging to show which part of the brain is engaged when people with addictions make decisions. A previous study determined that when people without addictions make general choices, a more primitive part of the brain becomes engaged, but when they make decisions about the future, a more modern part of the brain is engaged. It is possible, Bickel said, that addicts are making choices about the future in the more primitive part of the brain, which may not be able to rationalize beyond basic survival instinct.
“This is a great opportunity to collaborate and determine how addiction changes brain function as it invokes short term vs. long term gain,” he said.
For Oliveto, studies focus more on the pharmacology of drugs of abuse and how different medications may help relieve the powerful draw of addiction.
She said opiate-based drugs, like heroin, have well-established medical substitutes that can relieve withdrawal symptoms while the person receives therapy and learns to change his behavior. But for many drugs, there are no medical substitutes to quell the addictive urges.
“As long as I’ve been in this field we’ve been looking for a solution to cocaine addiction,” she said. She has already started recruitment for one trial on dual opiate and cocaine addiction. Another clinical trial will begin very soon on cocaine addiction and depression. This trial, which will place participants in a residential treatment center for two weeks and then continue therapy on an outpatient basis, will look closely at the time and percentage of relapse while participants are being medicated with various therapeutic drug combinations, including the antidepressant sertraline (Zoloft), an anti-convulsant and a placebo. Oliveto said that while most trials look closely at the initiation of treatment, few actually focus on relapse, which could hold clues on how and why addicts fall back into their old habits.
Bickel is in the process of recruiting well established investigators in the field of psychiatry to the new center at UAMS. He said he anticipates the work they will accomplish will have a far reaching influence, not just at UAMS, but across the state and region.
People interested in participating in the clinical trials can call 501-526-7969. All calls are confidential.
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