Logo from the radio program This American Life (Photo credit: Wikipedia)

Yesterday morning I re-posted from an article on the positive finding publication bias in psychology journals and how these findings live on in spite of the fact that they are never replicated and rely on shakey analysis.

Then, I’m driving to work and listen to last week’s episode of This American Life discussing psychopaths. It explored the case of a man in prison for 24 years who was presumably assessed to have antisocial personality disorder. (I say, “presumably” because they use the word psychopath throughout.)  It discussed the implication that this is assumed to be a life-long condition and that this diagnosis greatly diminished his likelihood of ever being paroled even though the man appears to have changed in very important and fundamental ways over the las 12 years.

It got me wondering about personality disorders. Where did this assumption that they are life-long, permanent conditions come from? In my experience, they are certainly long-term conditions. But, life-long? Over several decades? I don’t know. Is this assumption empirically based? Has anyone looked at these people over the course of 2, 3, 4 or 5 decades? If not, maybe we should speak with a little less certainty about these matters.

Positive results in psychology can behave like rumours: easy to release but hard to dispel. They dominate most journals, which strive to present new, exciting research. Meanwhile, attempts to replicate those studies, especially when the findings are negative, go unpublished, languishing in personal file drawers or circulating in conversations around the water cooler.

…

Psychology is not alone in facing these problems. In a now-famous paper, John Ioannidis, an epidemiologist currently at Stanford School of Medicine in California argued that “most published research findings are false”, according to statistical logic. In a survey of 4,600 studies from across the sciences, Daniele Fanelli, a social scientist at the University of Edinburgh, UK, found that the proportion of positive results rose by more than 22% between 1990 and 2007. Psychology and psychiatry, according to other work by Fanelli, are the worst offenders: they are five times more likely to report a positive result than are the space sciences, which are at the other end of the spectrum.

Related articles

• Psychology and the one-hit wonder (mindhacks.com)

Radiolab (Photo credit: Wikipedia)

I just listened to a Radiolab episode focusing on people’s attempts to control their future selves—to prevent themselves from doing something that they don’t want to do.

Here’s a video that, focusing on procrastination, illuminates the concept of your present self trying to control your future self. (It’s from a book called, You Are Not So Smart, not from Radiolab.)

The Radiolab episode had two segments that are relevant to addiction.

First, one on a reportedly common and troubling alcoholism treatment in Russia.

Next, a smoker who managed to quit by swearing that, if she relapsed, she would make a donation to the KKK.

Now, it’s easy for people to reduce addiction to an anecdote like this. There’s a lot more to quitting and staying quit than simply constructing the right motivational traps, but it does illustrate the role that structural factors can play in maintaining recovery.

A young female guinea pig (Photo credit: Wikipedia)

Published in a prestigious journal with an ‘n’ of 8. Unbelievable.

Participants  Eight cocaine-using adults.

Measurements  Subjects completed nine experimental sessions in which they were pre-treated with 0, 100 or 200 mg oral immediate release bupropion. Ninety minutes later they sampled an intranasal cocaine dose [4 (placebo), 15 or 45 mg] and made six choices between that dose and an alternative reinforcer (US$0.25), available on independent, concurrent progressive ratio schedules. Subjects also completed a battery of subject-rated, performance and physiological measures following the sample doses of cocaine.

Findings  After 0 mg bupropion, the high dose of cocaine (45 mg) was chosen five of six times on average compared to 2.25 of six choices for placebo cocaine (4 mg) (P < 0.05). Active bupropion reduced choice of 45 mg cocaine to 3.13 (100 mg) or 4.00 (200 mg) out of six drug choices on average. Bupropion also consistently enhanced positive subject-rated effects of cocaine (e.g. good effects; willing to take again) while having no effects of its own.

Conclusions  The atypical antidepressant, bupropion, acutely appears to reduce preference for intranasal cocaine versus a small amount of money but to increase reported positive experiences of the drug.

These changes were intended to clear up language problems, specifically the conflation of dependence and addiction leading to “false positives” for addiction. Looks like the DSM-5 is causing its own language problems before it’s even adopted. [emphasis mine]

Many scholars believe that the new manual will increase addiction rates. A study by Australian researchers found, for example, that about 60 percent more people would be considered addicted to alcohol under the new manual’s standards. Association officials expressed doubt, however, that the expanded addiction definitions would sharply increase the number of new patients, and they said that identifying abusers sooner could prevent serious complications and expensive hospitalizations.

Further, I’m pretty skeptical of the suggestion that the current abuse diagnostic category constitutes a medical illness requiring any kind of medical treatment, and they are looking forward to the new criteria being more inclusive and being classified as having form of addiction?

The article demonstrates that the inevitable slide into viewing low-severity AOD problems as the first stage of addiction:

“We can treat them earlier,” said Dr. Charles P. O’Brien, a professor of psychiatry at the University of Pennsylvania and the head of the group of researchers devising the manual’s new addiction standards. “And we can stop them from getting to the point where they’re going to need really expensive stuff like liver transplants.”

On top of this, conflicts of interest are being exposed. It’s pretty clear that this would be a major boon for drug companies, particularly with the Affordable Care Act simultaneously increasing access to healthcare for people with AOD problems and increasing physician responsibility to treat AOD problems that they are poorly equipped to address.

Some critics of the new manual have said that it has been tainted by researchers’ ties to pharmaceutical companies.

“The ties between the D.S.M. panel members and the pharmaceutical industry are so extensive that there is the real risk of corrupting the public health mission of the manual,” said Dr. Lisa Cosgrove, a fellow at the Edmond J. Safra Center for Ethics at Harvard, who published a study in March that said two-thirds of the manual’s advisory task force members reported ties to the pharmaceutical industry or other financial conflicts of interest.

Dr. Scully, the association’s chief, said the group had required researchers involved with writing the manual to disclose more about financial conflicts of interest than was previously required.

Dr. O’Brien, who led the addiction working group, has been a consultant for several pharmaceutical companies, including Pfizer, GlaxoSmithKline and Sanofi-Aventis, all of which make drugs marketed to combat addiction.

He has also worked extensively as a paid consultant for Alkermes, a pharmaceutical company, studying a drug, Vivitrol, that combats alcohol and heroin addiction by preventing craving. He was the driving force behind adding “craving” to the new manual’s list of recognized symptoms of addiction.

“I’m quite proud to have played a role, because I know that craving plays such an important role in addiction,” Dr. O’Brien said, adding that he had never made any money from the sale of drugs that treat craving.

Dr. Howard B. Moss, associate director for clinical and translational research at the National Institute on Alcohol Abuse and Alcoholism, in Bethesda, Md., described opposition from many researchers to adding “craving” as a symptom of addiction. He added that he quit the group working on the addiction chapter partly out of frustration with what he described as a lack of scientific basis in the decision making.

“The more people diagnosed with cravings,” Dr. Moss said, “the more sales of anticraving drugs like Vivitrol or naltrexone.”

Previous Posts:

• More on the DSM-V (addictionandrecoverynews.wordpress.com)
• Even more on the DSM-V (addictionandrecoverynews.wordpress.com)
• Almost alcoholic? (addictionandrecoverynews.wordpress.com)

Related articles

• Redefining addiction guidelines could impact insurers, taxpayers (seattletimes.nwsource.com)
• The New Psychiatric Manual (DSM-5) Will Make You Crazy (independentsentinel.com)
• Guideline revisions may sharply increase addiction diagnoses (mercurynews.com)
• D.S.M. Revisions May Sharply Increase Addiction Diagnoses (nytimes.com)
• Call For DSM-5 Reform Continues (madinamerica.com)
• DSM-5 Field Trials Fail to Compare New Diagnostic Criteria with DSM-IV Criteria (madinamerica.com)

Psychological Science (journal) (Photo credit: Wikipedia)

Whatever one thinks of AA’s spirituality, research suggests that thinking about God enhances self-control:

“The world is full of people who are fastidious about Biblical rules but can’t say no to fast food,” says Rabbi David Wolpe of Sinai Temple in Los Angeles. “There’s something about rules from God that make them easier to follow.”

According to research led by Kevin Rounding at Queen’s University in Ontario and recently published in Psychological Science, Rabbi Wolpe is right: People are better able to resist their desires when thinking about God. In a series of clever experiments, the Canadian scientists demonstrated that triggering subconscious thoughts of faith increased self-control.

Turns out that it may not even matter if you’re a believer:

The effect, it turns out, does not require religious belief. More than a third of the students in the studies were atheists or agnostics, yet the scientists found that they were still influenced by subconscious thoughts of God.

Charles Duhigg also suggested that faith is important in preventing habits from breaking down during periods of high stress.

Store bought cupcakes. (Photo credit: Wikipedia)

Ha!

If I read the phrase “as addictive as cocaine” one more time I’m going to hit the bottle.

Anything that is either overused, pleasurable or has become vaguely associated with the dopamine system is compared to cocaine.

In fact, here is a list of things claimed to be as addictive as the illegal nose powder in the popular press:

World of Warcraft
Power
Nicotine
Junk food
High-Fructose Corn Syrup
Ice cream
Cannabis
Love
Gambling
Fatty foods
Porn
Facebook
Sugar
Cupcakes
Running
Stories

And here is a scientifically verified list of things genuinely addictive as cocaine:

Cocaine

[via Andrew Sullivan]

Operation Mallorca, US Drug Enforcement Administration, 2005 (Photo credit: Wikipedia)

Mark Kleiman is making sense:

“For every complex problem,” H.L. Mencken wrote, “there is an answer that is clear, simple and wrong.”

That is especially true of drug abuse and addiction. Indeed, the problem is so complex that it has produced not just one clear, simple, wrong solution but two: the “drug war” (prohibition plus massive, undifferentiated enforcement) and proposals for wholesale drug legalization.

Fortunately, these two bad ideas are not our only choices. We could instead take advantage of proven new approaches that can make us safer while greatly reducing the number of Americans behind bars for drug offenses.

Our current drug policies do far more harm than they need to do and far less good than they might, largely because they ignore some basic facts. Treating all “drug abusers” as a single group flies in the face of what is known as Pareto’s Law: that for any given activity, 20% of the participants typically account for 80% of the action.

Thank goodness for commentary that avoids straw men and phony binary choices.

by Ross Hill

The Addiction Recovery blog at PsychCentral has a very good post explaining how mindfulness can help in addiction recovery.

Here are some quotes from clients that covey how they became “infected” by recovery carriers:

“He used to freak me out by saying things like, ‘Are you tired of living behind that mask?’ or he would call me when I was back using and ask, ‘How’s that high life working for you?’ He messed with my head, but he hung in with me,and I kept going back to him until I got my head together.”

“I could not write off ___(name) as I had so many other would-be helpers. It wasn’t even like he was helping. Others wanted to drop their pearls of wisdom and run. He was comfortable just being with me.”
“I knew if I wanted to stay out there in ‘the life,’ I needed to stay away from her ‘cause she was the ‘real deal.’”
“He kept telling me with this big smile on his face that I was full of shit but that he still loved me. He was telling the truth on both counts. I was and he did.”
“She kept calling to see how I was and to say she had been thinking about me at a time no one was thinking about me–even while she was going through cancer treatment. How does someone do that?”
“Everyone had threatened me or given me advice; he gave his story and gave me hope. He didn’t have any advice, only experience.”
“Every time I tried to praise her for all she had done, she would just smile and tell me she was just another drunk trying to stay sober and do what was right. I started thinking maybe I could be like her someday.”