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NIDA Science & Practice Perspectives

Volume 3, Number 1 - December 2005

From the Director

A Note From NIDA's Director
[PDF - 64K]

Nora D. Volkow, M.D.

From the Editor

Join the Conversation
[PDF - 48K]
David Anderson

Research Reviews

The Neurobiology of Cocaine Addiction
[PDF - 308K]
Eric J. Nestler, M.D., Ph.D.
Cocaine produces its psychoactive and addictive effects primarily by acting on the brain's limbic system, a set of interconnected regions that regulate pleasure and motivation. An initial, short-term effect—a buildup of the neurochemical dopamine—gives rise to euphoria and a desire to take the drug again. Researchers are seeking to understand how cocaine's many longer term effects produce addiction's persistent cravings and risk of relapse. In the author's laboratory, work has focused on buildup of the genetic transcription factor ΔFosB. Levels of ΔFosB in the limbic system correlate with addiction-like behaviors in mice and may precipitate very long-lasting changes to nerve cell structure. Further pursuit of this and similar leads are first steps toward a complete understanding of the transition from cocaine abuse to addiction—and, ultimately, more effective treatments for those who are addicted.

Mood Disorders and Substance Use Disorder: A Complex Comorbidity
[PDF - 452K]
Susan B. Quello, B.A., B.S., Kathleen T. Brady, M.D., Ph.D., and Susan C. Sonne, Pharm.D., B.C.P.P.
Mood disorders, including depression and bipolar disorders, are the most common psychiatric comorbidities among patients with substance use disorders. Treating patients' co-occurring mood disorders may reduce their substance craving and taking and enhance their overall outcomes. A methodical, staged screening and assessment can ease the diagnostic challenge of distinguishing symptoms of affective disorders from manifestations of substance intoxication and withdrawal. Treatment should maximize the use of psychotherapeutic interventions and give first consideration to medications proven effective in the context of co-occurring substance abuse. Expanded communication and collaboration between substance abuse and mental health providers is crucial to improving outcomes for patients with these complex, difficult co-occurring disorders.

Clinical Perspectives

Methadone Treatment at Forty
[PDF - 600K]
Ira J. Marion, M.A.

In the view of a clinician who has been providing methadone therapy since its inception 40 years ago, the status of the treatment today reflects the culmination of two trends: an increase in understanding, skills, and standards on the one hand, and a deterioration of patients' health on the other. A retreat of stigma, greater physician interest, and the evolution of standards are beginning to move the treatment toward the mainstream.

Stakeholders in Recovery: Demands, Expectations, and Research Opportunities
[PDF - 76K]
Dennis McCarty, Ph.D., Lucy Zammarelli, M.A., C.A.D.C. III, N.C.A.C. II, Hillary Wylie, M.A., M.S., C.A.D.C. III, N.C.A.C. II, M.A.C, and Merwyn R. Greenlick, Ph.D.

A broad array of agencies, institutions, and individuals interact with community-based substance abuse treatment programs, providing resources or services and asserting demands and expectations in return. These relationships shape the environment in which treatment and community-based research take place, and themselves raise issues worthy of research attention. This article enumerates the stakeholders in one well-established program and describes the scope of the program's efforts to accommodate these stakeholders, along with some of the complications and difficulties programs confront in their attempts to satisfy stakeholders, especially when their demands are unrealistic or their interests conflict. The article concludes by identifying research areas that could facilitate these relationships, enhancing their benefits for patients.

Science and Practice in Action

Research-Practice Partners Assess Their First Joint Project
[PDF - 112K]
Suzanne L. Wenzel, Patricia Ebener, Sarah B. Hunter, Katherine E. Watkins, and James M. Gilmore; with contributions from Yolanda M. Farley, Sara E. Huish, Consuela Jackson, James P. Morrow, Roselva Romero, and Shirley A. Summers
Investigators from RAND Corporation and community treatment providers at Behavioral Health Services joined forces to test an intervention to improve services for patients with co-occurring mental disorders. In the course of working together, the partners confronted many of the issues that typify research-practice collaborations in community settings. The researchers' applied theoretical understanding and the counselors' intimacy with patient responses combined to strengthen the intervention. However, counselors' discomfort with some protocols and changes reflecting the extremely dynamic nature of the community-based research setting complicated the study execution and interpretation. Despite these challenges, the intervention improved the counselors' ability to identify and respond appropriately to patients' co-occurring disorders, and one of its components was associated with improved patient outcomes. The experience also demonstrated the advisability of consulting collaboratively with clinic staff during the planning of studies and the pretesting of study protocols.

Authors, Contributors, and Respondents

This Issue's Authors, Contributors, and Respondents
[PDF - 52K]

Graphic Evidence

Stimulant Drug-Induced Changes to Brain Cell Structures
[PDF - 256K]

Continuing Education Quiz for Counselors

You can earn two nationally certified continuing education (CE) hours by reading the indicated articles and then printing out and completing this multiple-choice quiz. This is an open-book exam. Complete the quiz by circling one or more 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 March 31, 2006.
[PDF - 76K]

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