Presents current knowledge on a variety of addiction issues, including nicotine’s affects on brain function; inhalant abuse; genetically-based research and treatment; maternal tobacco use and its effects on children; and a behavior game for young children.
NIH Pub Number:
Published: July 2011
Author:National Institute on Drug Abuse
This issue presents an article by Drs. Manoranjan D'Souza and Athina Markou reviewing what researchers have discovered about how nicotine affects brain function and the prospects for medications to treat nicotine addiction. In addition, Dr. Matthew O. Howard and colleagues summarize the current state of understanding of inhalant abuse—its epidemiology, pharmacology, and consequences—and Dr. Alexandra Shields explores the ethical risks that genetically based research and treatment will bring along with their potential benefits. Dr. Alexandre Laudet advocates making patients' quality of life a measured outcome in substance abuse treatment and predicts that defining and standardizing criteria for quality of life will facilitate research and full recovery. Dr. Sonia Minnes and colleagues examine the damage that use of tobacco and other drugs by pregnant women inflicts upon their children. Finally, Dr. Shepard Kellam and his coauthors discuss the lessons learned from a longitudinal study of the Good Behavior Game played by first and second graders, which lowered their rates of aggressive and disruptive behaviors and later, when they reached young adulthood, corresponded to less smoking, illicit drug abuse, and violence.
From the Director
A Note From NIDA's Director
Nora D. Volkow, M.D.
From the Editor
Leaving the Banquet
Neuronal Mechanisms Underlying Development of Nicotine Dependence: Implications for Novel Smoking-Cessation Treatments
Manoranjan S. D'Souza, M.D., Ph.D., and Athina Markou, Ph.D.
Tobacco smoking causes high rates of mortality and morbidity throughout the world. Despite the availability of smoking-cessation medications, maintenance of long-term abstinence is difficult, and most individuals who attempt to quit smoking relapse. Although tobacco smoke contains many substances, researchers and policymakers agree that nicotine is a major cause of tobacco dependence. Understanding the neural substrates of nicotine dependence is essential for the development of more effective antismoking medications than those currently available. This article focuses on the neural substrates, especially nicotinic acetylcholine receptors, that mediate the reinforcing effects of nicotine and the development of nicotine dependence. Neuroadaptations in the function of the neurotransmitters dopamine, glutamate, and gamma-aminobutyric acid (GABA), which have been shown to be critically involved in nicotine dependence, are also reviewed. Finally, the article discusses progress in the discovery and development of smoking-cessation medications.
RESPONSE: A QUEST AND A WAGER
Rick Bevins, Ph.D., Paul Kenny, Ph.D., and Jed Rose, Ph.D.
Inhalant Use and Inhalant Use Disorders in the United States
Matthew O. Howard, Ph.D., Scott E. Bowen, Ph.D., Eric L. Garland, Ph.D., Brian E. Perron, Ph.D., and Michael G. Vaughn, Ph.D.
More than 22 million Americans age 12 and older have used inhalants, and every year more than 750,000 use inhalants for the first time. Despite the substantial prevalence and serious toxicities of inhalant use, it has been termed "the forgotten epidemic." Inhalant abuse remains the least-studied form of substance abuse, although research on its epidemiology, neurobiology, treatment, and prevention has accelerated in recent years. This review examines current findings in these areas, identifies gaps in the research and clinical literatures pertaining to inhalant use, and discusses future directions for inhalant-related research and practice efforts.
Ethical Concerns Related to Developing Pharmacogenomic Treatment Strategies for Addiction
Alexandra E. Shields, Ph.D.
Pharmacogenomics (PGx) research is poised to enable physicians to identify optimally effective treatments for individual substance abusers based on their genetic profiles. This paper addresses ethical issues related to PGx treatment strategies for addiction, focusing especially on the use of race variables in genomics research and ensuring equitable access to novel PGx treatments. Unless the field addresses the ethical challenges posed by these issues, PGx treatment innovations for addiction threaten to exacerbate already dramatic disparities in the burden of drug dependence for minority and other underserved populations.
The Case for Considering Quality of Life in Addiction Research and Clinical Practice
Alexandre B. Laudet, Ph.D.
Substance use disorders are increasingly viewed as chronic conditions, and addiction treatment services are beginning to adopt models that were developed to address other chronic conditions. These models address the impact of disease and services on the patient's overall well-being. From this perspective, treatment for addiction aims for the broad goal of recovery, which is defined as abstinence plus improved quality of life. However, the addiction field has come late to the chronic disease perspective, and the concept of quality of life in addiction is relatively undeveloped. This article reviews the evidence for the relevance of quality of life in substance use disorder treatment and recovery and discusses the importance of incorporating quality-of-life indices into research and services.
RESPONSE: TOWARD BETTER LIVES
Danny Hall, Ph.D., Dave Ross, Ph.D., and Lucy Zammarelli, M.A., N.C.A.C. II, C.A.D.C. III
Prenatal Tobacco, Marijuana, Stimulant, and Opiate Exposure: Outcomes and Practice Implications
Sonia Minnes, Ph.D., Adelaide Lang, Ph.D., and Lynn Singer, Ph.D.
Abuse of drugs by pregnant women both in the United States and worldwide has raised many questions regarding the effects of prenatal drug exposure on the developing fetus and subsequent child outcomes. Studies using the neurobehavioral teratology model have been undertaken to determine specific prenatal drug effects on cognitive and behavioral development. Here we summarize the findings of studies that have investigated the developmental effects of prenatal exposure to tobacco, marijuana, stimulants, and opiates. These studies consider the timing and amount of prenatal exposure; other drug exposures; maternal characteristics; and other health, nutritional, and environmental factors. We review treatment options for pregnant, substance-dependent women and therapeutic interventions for exposed children.
RESPONSE: HOW TO USE A WINDOW OF OPPORTUNITY
Margaret S. Chisolm, Ph.D., and Victoria H. Coleman-Cowger, Ph.D.
Science and Practice in Action
The Good Behavior Game and the Future of Prevention and Treatment
Sheppard G. Kellam, M.D., Amelia C. L. Mackenzie, B.S., C. Hendricks Brown, Ph.D., Jeanne M. Poduska, Sc.D., Wei Wang, Ph.D., Hanno Petras, Ph.D., and Holly C. Wilcox, Ph.D.
The Good Behavior Game (GBG), a universal classroom behavior management method, was tested in first- and secondgrade classrooms in Baltimore beginning in the 1985-1986 school year. Followup at ages 19-21 found significantly lower rates of drug and alcohol use disorders, regular smoking, antisocial personality disorder, delinquency and incarceration for violent crimes, suicide ideation, and use of school-based services among students who had played the GBG. Several replications with shorter followup periods have provided similar early results. We discuss the role of the GBG and possibly other universal prevention programs in the design of more effective systems for promoting children's development and problem prevention and treatment services.
Authors and Respondents
- This Issue's Authors and Respondents
- Maturing Brain: His and Hers
Continuing Education Quiz for Counselors
- Substance abuse counselors can earn two nationally certified continuing education (CE) hours by reading the indicated articles and completing the multiple-choice quiz. This is an open-book exam. Complete the quiz by circling one of the multiple-choice answers. Be sure to answer all questions; unanswered questions will be scored as incorrect. You must score at least 70 percent to earn CE hours. Please note that we must receive your quiz by September 15, 2011.
Addiction Science & Clinical Practice
Following the publication of Volume 6, Number 1, NIDA will no longer be the publisher of Addiction Science & Clinical Practice. The journal will subsequently be published by Biomed Central and can be found at ascpjournal.org.
As a result of scientific research, we know that addiction is a disease that affects both brain and behavior.