Briefly Noted

Clayton Stafford died after using Vivitrol, and his family is suing Alkermes, the manufacturer, saying that the medication doesn't adequately treat addiction, compared to buprenorphine and methadone, and that the manufacturer knew this. In the lawsuit, California‐based law firm Lieff Cabraser alleges that Stafford, his parents and his treatment providers were misled into thinking Vivitrol was an appropriate treatment for his opioid use disorder. “Clayton Stafford's tragic death could have been avoided,” notes Lieff Cabraser partner Fabrice N. Vincent, who filed the lawsuit on behalf of the Stafford family. “The well‐reported defects in Vivitrol made Clayton's overdose a near‐foregone conclusion, and had the Staffords received accurate information about Vivitrol's risks and effective deficiencies from Alkermes, they would never have consented to its use by Clayton.” Naltrexone doesn't work to treat addiction and cravings, but just to block the effects of opioids, according to the lawsuit (and many others agree with this). “Because the patient's addiction is not adequately treated, the patient requires indefinite Vivitrol use to merely block the euphoric effects and keep the patient from seeking opiates,” Vincent said. “Patients therefore remain highly likely to relapse despite indefinite use of Vivitrol.” The lawsuit also makes note of Alkermes' direct‐to‐consumer marketing campaign, which extended into influencing the criminal justice system to use Vivitrol. Stafford had been mandated to use Vivitrol. Last year, the Food and Drug Administration issued a warning letter to Alkermes stating that its advertising did not state that stopping Vivitrol can lead to relapse and overdose, as is clearly stated by the label and package insert (see “FDA warns Alkermes about OD risk on Vivitrol ads,” ADAW, Dec. 16, 2019, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32566 ).     

Dostoevsky and Freud: Autonomy and Addiction in Gambling

In this paper the modern ideal of “autonomous” or “pure” gambling is put forward in an analysis of Dostoevsky's gambling behavior, his novel The Gambler (1866) and Freud's psychoanalysis of Dostoevsky. The significance of The Gambler lies in the way conceptions of gambling are related to the social conditions of gamblers. Furthermore, the author demonstrates that Dostoevsky and Freud express contradictory views on gambling addiction. While Dostoevsky primarily appreciated roulette as a means of making money, Freud mistakenly interpreted this as a “pathological passion”. In different ways, however, both approaches toward excessive gambling presuppose and reinforce “gambling‐for‐its‐own‐sake” – Le jeu pour le jeu.     

Psychodynamic therapy for SUD: Counselor's view

First of all, psychodynamic psychotherapy as treatment for substance use disorder (SUD) works. Ian McLoone, lead therapist with the Alltyr Clinic in Minneapolis, knows that firsthand — he's in recovery from heroin addiction and is in it himself. And despite the fact that addiction therapists aren't taught psychodynamic theory or psychoanalytic psychotherapy in graduate school, where cognitive behavioral therapy (CBT), motivational interviewing (MI) and, to a lesser degree, 12‐Step facilitation are stressed, he became interested in it mainly because of his employer, Mark Willenbring, M.D., a psychiatrist and former medical director of the National Institute on Alcohol Abuse and Alcoholism. We talked to McLoone for this story as a follow‐up to our article on the self‐medication hypothesis of addiction, for which we interviewed its developer, Ed Khantzian, M.D. (see “Psychodynamic psychotherapy: When it helps people in recovery,” ADAW, June 22, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32756 ).     

Life Balance and Work Addiction Among NCAA Administrators and Coaches

Intercollegiate athletics represent an industry prone to challenges of work addiction and life balance. Work addiction and life balance domains in male and female intercollegiate athletic coaches and administrators (N = 245) were examined using multiple regression analysis. Higher levels of stress/anxiety, sleep disturbance, and career satisfaction and lower levels of quality of relationships and friendships were the strongest predictors of work addiction. Counseling focused on reducing the negative aspects of work addiction, while maintaining job performance, may benefit this population.     

The influence of unconscious fantasy process in addictions and relapse

This discussion reaffirms the connection between addiction and underlying unconscious fantasy process. It suggests that unconscious fantasies play a determining role in persisting patterns of substance abuse and addiction. Within this context, addiction is understood both as a derivative of thepersistence of these unresolved fantasies and an inadequate compromise formation. It suggests that relapse is a manifestation of the episodic reassertion and influence of these powerful fantasies. Consequently, successful treatment requires the working through of the underlying fantasy process and the establishment of healthier compromise formations.     

Names in the News

Bankole A. Johnson, M.D., DSc., until March 26 chairman of the board of directors of Adial Pharmaceuticals, is now chief medical officer of the company, which is about to start a Phase 3 clinical trial of AD04 (low‐dose ondansetron) for alcohol use disorder (see ADAW, March 25). Johnson will also leave his position as chair of the Department of Psychiatry at the University of Maryland. “I am delighted to join the senior management team of Adial as we work toward our goal of developing the leading addiction company,” Johnson said in a press statement March 26.     

Response to Shaffer (1996): The Case for a 'Complex Systems' Conceptualisation of Addiction

This paper responds to some of the issues raised by Shaffer's (1996) paper, Understanding the Means and Objects of Addiction. The authors agree with, and in many respects support, the assertions made by Shaffer with respect to the conceptualisation of the problem of addiction. In particular, that it is the relationship of the addicted person with the object of their behaviour that defines addiction. However, it is argued that in addition to providing an operational definition for addiction, it is important to provide an explicit framework for the development of insight into the 'synergistic nature' of the multiple factors affecting the addiction process. That is, it is necessary to account for both the commonalities and the differences found across the spectrum of addictive behaviours. It is proposed that this might be provided by a 'complex systems' approach to the field of addiction.     

Briefly Noted

Researchers have found that attention‐deficit hyperactivity disorder (ADHD) may be a risk factor for developing smartphone addiction, based on the neurobiological substrates underlying each separately and those that are shared. The study found a greater than six times likelihood that children with ADHD also had smartphone addiction. The study looked at the prevalence of smartphone addiction and its association with depression, anxiety, and ADHD symptoms in a total of 4,512 South Korean middle and high school students, who completed surveys. There were 338 subjects (7.5%) in the smartphone addiction group. The odds ratio of the ADHD group compared to the non‐ADHD group for smartphone addiction was 6.43, the highest among all variables. The study, “The relationship between smartphone addiction and symptoms of depression, anxiety, and attention‐deficit/hyperactivity in South Korean adolescents” is published in the March issue of the Annals of General Psychiatry.     

Australian Family Therapy: Have We Lived Up To Our Mission Statement?

In 1983 the Fourth Australian Family Therapy Conference had the theme ‘Merging the Streams — Integrating Trends in Family Therapy’. In his keynote address Brian Stagoll outlined concerns regarding the nature of family therapy as it was then developing in Australia. This article revisits some of these themes to see where we have come from, where we are heading and which topics continue to be ignored. Evidence is drawn from articles that stood out for me in the Australian Journal of Family Therapy (later the Australian and New Zealand Journal of Family Therapy) and selected relevant papers from the 1983 conference itself. Finally, I speculate upon possible reasons for the absence of discussion on certain issues, most strikingly: systemic influences upon indigenous Australians, farm families, working with children in families, certain aspects of gender, the systemic implications of addiction; and environmental impacts on families now and for the future. The danger for family therapy is becoming stuck in a closed system that ignores the wider system.     

A Strengths Perspective in Working with an Adolescent with Dual Diagnosis

Dual diagnosis has gradually become a problem among adolescents in Hong Kong. In working with persons with dual diagnosis, professionals are accustomed to use a disease model in diagnosis, treatment, and rehabilitation. By means of a case illustration, the writer tries to contrast a disease orientation and a strengths perspective in working with persons with dual diagnosis. The disease orientation stresses: addiction and mental illness; intoxication and dependence; symptoms and diagnosis; detoxification and treatment; confusion and control as well as resistance and labeling. The strengths perspective focuses on: decoding frustration and emptiness from addiction; searching for strengths to satisfy normal needs; establishing social support and encouraging participation in a healthy environment; re-anchoring self-confidence and capability development as well as maintaining empathetic trust. In this case, with the strengths perspective, the writer successfully helped an adolescent to re-build his self-confidence and re-establish a healthy social support system to live a normal life.     

Under 2% of Medicaid‐covered youths get MAT after OD: Study

Fewer than one‐third of youths receive addiction treatment after an opioid overdose, and only one in 54 receive pharmacotherapy (methadone, buprenorphine or naltrexone), a study published in JAMA Pediatrics reports. The researchers urge interventions to link these youths to treatment after an overdose, and call for improving access to medications: methadone, buprenorphine, and naltrexone.     

Personality characteristics of sexual addicts and pathological gamblers

Personality characteristics of three groups were compared: sexual addicts (N=32, 6 females, 26 males, ¯x age=36.37), pathological gamblers (N=32, 13 females, 19 males, ¯x age=46.15), and non-addicts (N=38, 13 females, 25 males, ¯x age=39.65). The sexual addict group was significantly more anxious, depressed, obsessive-compulsive and interpersonally sensitive than the non-addict control group. The sexuai addict group was significantly more depressed than the pathological gambler group. The pathological gambler group was significantly more depressed than the non-addict control group, but was not significantly more anxious, obsessive-compulsive, or interpersonally sensitive. Neither addict group scored higher on levels of sensation-seeking or self-defeating behaviors than did the non-addict control group. The results supported the view that sexual addiction can be explained as a means of coping with anxiety, depression, obsessive-compulsiveness and interpersonal sensitivity whereas pathological gambling may be used as an anti-depressant but there is no significant relationship between that addiction and the other above-mentioned personality characteristics.     

Recovery,reinstatement, serenity: The personal account of a compulsive gambler

A lawyer, investment banker, and certified public accountant who committed crimes to support his gambling addiction describes the process of reinstatement after suspension, the feelings of frustration and despair, and the support he received from Gamblers Anonymous.Editor's Note: Adherence to the principles of the Gamblers Anonymous program made it incumbent upon the author to maintain his anonymity for this article.     

A MODEL OF ADDICTION AND SOCIAL INTERACTIONS

Many consumer behaviors are both addictive and social. Understanding how these two phenomena interact informs basic models of human behavior, and matters for policymakers when the behavior is regulated. I develop a new model of demand that incorporates both addiction and social interactions and show that, under certain conditions, social interactions reinforce the effects of addiction. I also show how the dynamics introduced by addiction can solve the pernicious problem of identifying the causal effects of social interactions. I then use the model to illustrate a new and important identification problem for studies of social interactions: existing estimates cannot be used to draw welfare conclusions or even to deduce whether social interactions increase aggregate demand. Finally, I develop a method that allows researchers to distinguish between two common forms of social interactions and draw welfare conclusions. (JEL D11, H20)     

Parity getting worse,not better: Milliman report

Medical and behavioral (addiction and mental health) care are further apart now than they were two years ago, according to a study published by Milliman Inc. last week. The report, commissioned by the Bowman Family Foundation, shows that the gap for employees and their families between mental/addiction care and medical/surgical care is widening. The report, Addiction and Mental Health vs. Physical Health: Widening Disparities in Network Use and Provider Reimbursement, is based on actual claim data in 50 states for 37 million employees and their dependents.     

Asthma and allergy as risk factors for suicidal behavior among young adults

An association between allergic disease, depression and suicidality has been reported. Objective: To explore the relationships between suicidality and asthma, allergy, internet addiction, stress, sleep quality, pain/discomfort, and depression, among emerging adults. Participants: 929 college students completed an online survey between October 2015 and April 2017. Methods: A cross-sectional study using multivariate analysis techniques was implemented. Results: Using structural equation modeling, we found that allergies and stress were directly related to pain/discomfort; pain/discomfort was associated to poor sleep, depression, and suicidality. Sleep quality was also affected by stress; while sleep, stress, pain/discomfort, and internet addiction were directly related to depression (all p < .05). Ultimately, four factors impacted suicidality: stress, pain/discomfort, depression, and, indirectly, sleep quality (all p < .05). Although allergy had some effects, these did not reach statistical significance (p < .09). Conclusion: Findings suggest that allergy might impact suicidality indirectly through increased pain/discomfort, poor sleep, and depression.     

Sociology and American drug policy

American drug policy is structured around a punitive model. Although sociologists have made major contributions to the drug abuse research literature, they have been absent in the formulation of drug policy. Ever since the first systematic study of drug addiction by a sociologist was conducted during the 1930s, sociologists have lacked credibility in the eyes of policy makers. Studies of addiction and crime have been biased by methodological flaws, and sociological theories of addiction have had little relationship to the real world of drug abuse. Moreover, sociologists have generally offered radical, simplistic, and unworkable recommendations for dealing with the problems associated with drug use. The pragmatic approach for sociologists involves using the tools of their science within the context of existing policy—to reduce drug abuse and thereby limit the need for punitive controls. He received his Ph.D. in sociology at New York University. He has extensive research and field experience in substance abuse, and has published more than 100 books and articles in the areas of drug abuse, history, folk lore, criminology, medicine and law.     

Briefly Noted

A project that began a year ago (see ADAW, Jan. 15, 2018), Shatterproof's rating system of addiction treatment programs took another step last month when the nonprofit announced it would start out with a pilot, now that it has $5 million. Saying the current addiction treatment system is broken, Shatterproof founder and CEO Gary Mendell said the project was made possible by funding from two foundations (the Laura and John Arnold Foundation and the Robert Wood Johnson Foundation) and a coalition of five insurance companies. “People who need help for addiction don't know what to look for or where to turn,” said Sam Arsenault, director of national treatment quality initiatives at Shatterproof, in the Dec. 18 announcement of the project. “We are taking rating system best practices from health care and other business sectors and applying them to addiction treatment. This will not only provide critical information to individuals looking for care but also drive a long overdue transformation of the addiction treatment industry.” The Shatterproof Rating System will utilize data from three sources: insurance claims, provider surveys and consumer experience, with collaboration from the National Quality Forum (NQF), a membership organization composed of payers. Initially, the program will begin with a pilot, with analysis done by RTI International. “Consumers can find information and accurate data on the quality of nursing homes, hospitals, physicians and most other types of providers,” said Tami Mark, director of behavioral health financing and quality measurement at RTI International. “It's time that patients have reliable information on addiction treatment.”     

Therapists’ Assessments in Treating “Sex Addiction” and Their Relationship to Clients’ Gender,Relationship Status,and Exclusivity Status

A total of 208 therapists and therapists‐in‐training were surveyed to better understand if clinical assessments and recommendations regarding “sex addiction” changed based upon a client's gender, relationship status, or exclusivity status. Using clinical vignettes, this study examined the clinical assessment and recommendations of licensed mental health providers (n = 92) and mental health providers in‐training (n = 116). Results indicated that professional ratings differed based on relationship exclusivity and gender; specifically, female nonmonogamous behavior was rated more negatively than male nonmonogamous behavior, while male monogamous behavior was rated more negatively than female monogamous behavior. Recommendations for treatment varied, with higher addiction ratings leading to greater odds of recommending individual, group, and community support over relational therapy. Clinical and training implications are discussed. Video abstract accessible by clicking here .