I did not purposely set down to write this work but was compelled by a painful sense of what I should not do. What I should not write. To protect the privacy and autonomy of individuals, to avoid creating harm, and to resist, however unsuccessfully, essentializing either “mothers” or “addiction,” this work enacts a radical besideness, where one subject performs the verb of a second subject, where one subject enlist the aid of other subjects. In the aim of both producing and defying narrative structures that seem to fasten a person to their identity, this collaborative, intertextual project attempts to tell a story, both in what is re-told and in what is not-told. It invokes infelicitous performances as a way of talking back while walking forward. / Graduate

Studies have shown that aberrant activity in some brain regions involved in the pathology of OCD overlaps similarly with individuals with addiction disorders. The reduced anxiety following a compulsion together with findings of diminished activation in the striatum during reward anticipation proposes a view of OCD being a behavior addiction. To investigate if there are consistent results across studies that support this view a systematic search of the literature was conducted. The keywords in the final search string used were: Obsessive-compulsive disorder, OCD, reward, risk, functional MRI, MRI, fMRI. Databases used for the search were Web of Science and PubMed. The inclusion criteria were studies that compared the neural activity during the anticipation phase of reward between OCD patients and healthy controls. The intervention and brain imaging used in the included studies were the monetary incentive delay task and fMRI. The main data extracted were the alterations in the striatum. Four studies were included in this review with inconsistent results. Three studies did not find any significant difference between OCD and healthy controls and therefore the findings in principle did not support the view of OCD being a behavior addiction. However, differences in study design between studies could be an explanation for the conflicting findings.

TOPIC. Despite substantive advances in understanding of genetic and biochemical basis of substance abuse and addiction in the last decade, little information has been translated into alternative treatment models for the addicted patient. Rapid detox, an alternative form of detox treatment, is gaining in both acceptance and popularity. PURPOSE. To increase readers' understanding of the neurobiology of addiction and the mode of action of new detox approaches for patients addicted to opiate drugs. SOURCES. A review of the current literature pertaining to rapid detox. CONCLUSIONS. Rapid detox is a viable alternative for selected patients attempting to detox from opiate agents of abuse. Increasing knowledge of new treatment approaches allows nurses working to assist addicted patients in planning and receiving treatment based on new awareness of the neurobiology of addiction.

The rewarding properties of drugs in the mammalian system depend on their ability to activate appetitive motivational states. The associated underlying mechanism is strongly conserved in evolution and invertebrates have recently emerged as a powerful new model in addiction research. The natural reward system in crayfish has surprisingly proven sensitive to human drugs of abuse, providing a new model for research into the basic biological mechanisms of drug addiction. In this study, we examined the presence of natural reward systems in crayfish, and then characterized its sensitivity to 2.5 μg/g, 5.0 μg/g and 10.0 μg/g doses of methamphetamine (METH). Using the conditioned place preference (CPP) paradigm, we demonstrated that irrespective of the number of doses of METH injected into the pericardial system, crayfish seek out a particular tactile environment that had previously been paired with the METH. This study demonstrates that crayfish offer a comparative and complementary approach in addiction research. It contributes an evolutionary context to our understanding of a key component in learning and of natural reward as an important life-sustaining process.

Hypocretin/Orexin (HCRT) is a neuropeptide that is associated with both stress and reward systems in humans and rodents. The different contributions of signaling at hypocretin-receptor 1 (HCRT-R1) and hypocretin-receptor 2 (HCRT-R2) to compulsive alcohol drinking are not yet fully understood. Thus, the current studies used pharmacological and viral-mediated targeting of HCRT to determine participation in compulsive alcohol drinking and measured HCRT-receptor mRNA expression in the extended amygdala of both alcohol-dependent and non-dependent male rats. Rats were made dependent through chronic intermittent exposure to alcohol vapor and were tested for the acute effect of HCRT-R1-selective (SB-408124; SB-R1), HCRT-R2-selective (NBI-80713; NB-R2), or dual HCRT-R1/2 (NBI-87571; NB-R1/2) antagonism on alcohol intake. NB-R2 and NB-R1/2 antagonists each dose-dependently decreased overall alcohol drinking in alcohol-dependent rats, whereas, SB-R1 decreased alcohol drinking in both alcohol-dependent and non-dependent rats at the highest dose (30 mg/kg). SB-R1, NB-R2, and NB-R1/2 treatment did not significantly affect water drinking in either alcohol-dependent or non-dependent rats. Additional PCR analyses revealed a significant decrease in Hcrtr1 mRNA expression within the central amygdala (CeA) of dependent rats under acute withdrawal conditions compared to nondependent rats. Lastly, a shRNA-encoding adeno-associated viral vector with retrograde function was used to knockdown HCRT in CeA-projecting neurons from the lateral hypothalamus (LH). LH-CeA HCRT knockdown significantly attenuated alcohol self-administration in alcohol-dependent rats. These observations suggest that HCRT signaling in the CeA is necessary for alcohol-seeking behavior during dependence. Together, these data highlight a role for both HCRT-R1 and -R2 in dependent alcohol-seeking behavior.

Prescription drug abuse has been a growing problem in Indiana and around the nation for almost two decades. In recent years, prescription drug overdoses have pushed drug poisonings ahead of motor vehicle crashes as the leading cause of injury death. However, deaths due to overdoses of prescription drugs are only the tip of the iceberg when it comes to the much larger problem of abuse. This study has characterized prescription drug abuse in Indiana and taken an in-depth look at how it is and can be addressed both through organizational policies and state legislation. Opioid painkillers such as hydrocodone, oxycodone, and methadone are the most commonly abused prescription drugs, and most of these prescriptions are written by primary care physicians. Because more than 70% of Indiana’s family medicine residents will remain in the state to practice medicine following the conclusion of their residencies, it is worthwhile to take a look at how these residents are being educated during their training. St. Vincent’s Family Medicine Residency program in Indianapolis is one of several residency programs in Indiana training their residents on best practices of prescribing controlled substances. A review of residents’ prescribing patterns before and after training on the subject went into effect showed significant reductions in the number of opioid painkillers being prescribed, and showed the same reductions for alprazolam, a benzodiazepine anxiolytic.

Contingency management (CM), an intervention that typically provides financial incentives for abstinence, has also been applied to treatment engagement. However, little is known about the magnitude of treatment effects when financial incentives are provided for attendance. A systematic search was conducted to identify studies that included incentives for attendance, either in isolation or in combination with incentives for abstinence. Meta-analysis was used to estimate the effect sizes on treatment attendance and abstinence. A total of 10 studies including 12 CM treatments (6 incentives for attendance only and 6 incentives for both attendance and abstinence) with 1,673 participants were identified. Results indicated a moderate effect (d = 0.47, 95% confidence interval (CI) [0.24, 0.68]) on attendance relative to non-reward active comparison conditions, p <.001. Frequency of incentives for attendance was significantly associated with larger effect sizes. Results also indicated a small effect (d = 0.22, 95% CI [0.11, 0.32]) on abstinence relative to non-reward comparisons, p <.001. Overall, this meta-analysis supported financial incentives for attendance to increase treatment engagement, with smaller effects on abstinence compared to those observed in meta-analyses on financial incentives for abstinence. Although financial incentives for attendance increased clients' attendance, the impact on abstinence was weaker than conditions that included both incentives for attendance and abstinence. Clinics implementing CM should consider these differential effects in the selection of reinforcement targets.

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Addiction has been predominantly viewed through the lens of the individual, thereby leaving the family largely out of the scope of treatment or prevention. Csiernik (2002) calls the family the ‘secondary element’ in addiction treatment. The definitions of addiction and research on the prevalence of use are examples of this narrow, individual focus. This qualitative study sought to widen the lens and explore the family’s experiences of addiction. Families’ voices will be presented and their perspectives captured regarding what would be helpful to them in addiction treatment. This study’s theoretical underpinnings are Family Systems Theory and Social Constructionism. Interviews with the participants were conducted through the use of an open-ended interview process. Interpretive data analysis and phenomenology were used to explore possible themes and meanings to gain a better understanding of the participants’ perspectives regarding addiction. The main finding of this study, based on the testimony of the participants, was that families perceived there to be a need for more clinical and supportive services to deal with the impact of addictions on the family. This study fills a gap in the literature because, though there is ample research on the consequences of addiction for the family, there is very limited research on the family’s perspective regarding what services they require in order to cope with those consequences. The information supplied by the participants of this study will help social workers and treatment centers provide more holistic, family-centered addiction treatment. / Thesis / Master of Social Work (MSW)

This article examines the socio-political intricacies of the United States Opiate Crisis. By first addressing the pharmaceutical origins of Oxycontin and its pain relief benefits within the United States, I construct a framework by which a conversation about substance abuse can move forward. Within the first chapter I provide background into the arguments for medicalization against personal responsibility as it relates to opiate withdrawal and seeking treatment for the prior. Furthermore, I include subheadings to further provide insight into Medically Assisted Treatment Centers and their function on the local level. I contrast these modern treatment models with the Reagan War on Drugs mentalities and illustrate a larger societal tonal shift towards increased medicalization. My second chapter addresses the bulk of my theoretical frameworks, including spatial and feminist theories to construct an argument about patriarchal dominance in relation to factors such as homelessness, race, and socioeconomic status. Finally, in my third chapter I examine the current debate regarding whether or not the U.S. Opiate Crisis can truly be considered a crisis. I address the arguments for why it could still be considered a widespread crisis, and end on the central argument for the crisis being a symptom of Disease of Despair.