December 2021

“Rat Park” and Vietnam – research focuses on the role of environment in addiction; Assess people’s social environment; Educator of the Year Award

In SAVVY, two research studies from the 1970s remind us of the role of the environment in the development and continuation of addiction. Access Michael Pollan’s episode on Science Friday to hear about three plant-based compounds from the three major categories of psychoactive drugs– uppers, downers, and what he thinks of as outers.

In SKILLS, do you focus on your clients’ families, their social communities, their sources of human contact and support? Assessing their social environment is as important as their mental and physical health assessment.

In SOUL, David Mee-Lee, MD, DFASAM, Named ASAM’s Educator of the Year. What that means and how it feels.

savvy

On Science Friday this month, Ira Flatow interviewed Michael Pollan who is the Knight Professor of Journalism at Berkeley. He is the author of multiple books, including How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression and Transcendence and The Omnivore’s Dilemma.

It was on his latest book, “This Is Your Mind on Plants” (Penguin Press, 2021), that was the basis of the December 10, 2021 interview on Three Plant-Based Chemicals That Can Change Your Brain.

In this episode, Pollan talked about three plant-based compounds from the three major categories of psychoactive drugs– uppers, downers, and what he thinks of as outers.  The stimulant was caffeine; the depressant was opium produced by the opium poppy; and the psychedelic was mescaline, which is produced by a couple different cacti.

The interview looked at “the science behind their action, the history of their use around the world, and the societal and cultural factors that go into deciding which drugs are seen as acceptable by a community.”  You can listen for yourself if you are interested.

In SAVVY, I focus on two classic research studies that Pollan discussed that point to the power and importance of the social environment in developing addiction.

Tip 1

To understand addiction, remember the underlying connection between a person’s environment and addiction – The “Rat Park”

American psychologist, Dr Bruce Alexander, advanced our understanding that addiction is about far more than any drug and its neurochemistry. His experiments of the 1970s tested whether addiction might be more related to the setting the drugs are used in.

Lloyd I. Sederer, MD and Steph L. summarized Alexander’s research. I have summarized their summaries.

Prior to Alexander’s experiment, addiction studies using lab rats did not alter the rat’s environment. The scientists:

  • placed rats in tiny, isolated cages 
  • starved them for hours on end
  • made it incredibly easy for rats to take the drugs, and offered no alternatives.
  • used “Skinner Boxes” where the rats lived in 24/7 with no room for movement 
  • provided no interaction with other rats.

Using the Skinner Boxes, scientists hooked rats up to various drugs using intravenous needles implanted in their jugular veins. The rats could choose to inject themselves with the drug by pushing a lever in the cage. Scientists studied drug addiction this way, using heroin, amphetamine, morphine, and cocaine. Typically, the rats would press the lever often enough to consume large doses of the drugs until they all overdosed and died.  

Results of the Skinner Boxes:

  • The caged rats ingested much larger doses of the morphine solution – about 19 times more than Rat Park rats in one of the experiments.
  • The studies thus concluded that the drugs were irresistibly addicting by their specific properties.

The “Rat Park”

Rats by nature are social, industrious creatures that thrive on contact and communication with other rats. 

  • Putting a rat in solitary confinement does the same thing as to a human, it drives them insane. 
  • If prisoners in solitary confinement had the option to take mind-numbing narcotics, they likely would. 

Alexander wondered: Is this about the drug or might it be related to the setting they were in? To test his hypothesis, he put rats in “rat parks,” where: 

  • They were among others and free to roam and play
  • There were wheels and balls for play
  • They could socialize; had plenty of food and mating space
  • 16-20 rats of both sexes were mingling with one another
  • They were given the same access to the same two types of drug laced bottles. 

Results of the “Rat Park”:

  • When inhabiting a “rat park,” the rats consistently resisted the morphine water, preferring plain water.
  • Even when they did imbibe from the drug-filled bottle they did so intermittently, not obsessively, and never overdosed.
  • Even rats in cages that were fed nothing but morphine water for 57 days chose plain water when moved to Rat Park, voluntarily going through withdrawal.
  • Alexander tested a variety of theories using different experiments with the Rat Park to show that the rat’s environment played the largest part in whether a rat became addicted to opiates or not.
  • A social community beat the power of the drugs.
  • No matter what they tried, Alexander and his team produced nothing in the Rat Park rats that resembled addiction in rats that were housed in Skinner Boxes.

Conclusions

  • A person’s mental, emotional, and psychosocial states were the greatest cause of addiction, not the drug itself.
  • A person’s environment feeds an addiction. Feelings of isolation, loneliness, hopelessness, and lack of control based on unsatisfactory living conditions make a person dependent on substances. 
  • Humans, not just rats, need to be part of a community, encouraged to relate and experience the support of others. 

Lloyd I. Sederer, MD is Adjunct Professor, Department of Epidemiology, Columbia University Mailman School of Public Health, Distinguished Psychiatrist Advisor to the New York State Office of Mental Health (OMH) and Director, Columbia Psychiatry Media.

About Steph L.: Stephanie is a writer for Serenity at Summit and has dedicated her career to creating well-researched content so that those that are in search of treatment can find the help they need.

References:

1. Alexander BK, Beyerstein BL, Hadaway BF, Coombs RB. Effect of Early and later colony housing on oral ingestion of morphine in rats. Pharmacol Biochem Behav. 1981;15:571-576.

2. Sederer LI. The medical irony of the deadly opioid epidemic. Psychiatric Times. May 15, 2019. https://www.psychiatrictimes.com/substance-use-disorder/medical-irony-deadly-opioid-epidemic. Accessed May 30, 2019.

3. Steph L.  What You Need to Know About The Rat Park Addiction Study.  Serentity at Summit, October 13, 2019. https://serenityatsummit.com/ne What You Need to Know About The Rat Park Addiction Studyws/overview-rat-park-addiction-study/

Tip 2

The Vietnam-era study on the role of environment in addiction

More research of the 1970s came at the end of the Vietnam War and the need to look at the environment in which people get addicted.

Lauren Aquirre summarized this Vietnam-era study of addiction. 

  • In Vietnam, soldiers had easy access to heroin that was cheap and potent. Something like 20% of American troops were using heroin regularly. 
  • All had been in the country for one year, so their exposure to the drug-rich environment was essentially the same.
  • There was a lot of worry that when these thousands of soldiers using addictive drugs came back to the streets of the US, we’d have a tremendous heroin addiction problem.
  • In September 1971, every soldier scheduled to return home had a urine test to check for drug use.
  • Soldiers knew that a positive test meant they would be sent to detox for six to seven days. Based in part on this information, the researchers assumed these men were unable to stop using and had become addicted.
  • But when the soldiers got back, 95% of them were able to simply stop using heroin without any treatment, without much problem at all and only 5% continued after 8 – 12 months; and only 12% had relapsed after three years.
  • This suggested that it was the environment, the conditions in which people were living that was determining whether they became addicted or not.

Conclusions

  • The finding that the availability of a given drug is a key to how much it’s used is obvious and uncontroversial.
  • Some people appear to be more vulnerable to addictive drug use in general (genetic and family predisposition).
  • Those who became addicted to heroin in Vietnam were more likely to have had social problems before they arrived in the country and used marijuana, alcohol, amphetamines, and other substances while there.

Lauren Aguirre is a science journalist and author of “The Memory Thief and the Secrets Behind How We Remember — A Medical Mystery” (Pegasus Books, June 2021), from which this essay is adapted.

Reference:

Lauren Aguirre  – Lessons learned — and lost — from a Vietnam-era study of addiction. STAT. July 19, 2021

skills

Do you focus on your clients’ and patients’ families, their social communities, their sources of human contact and support?

Tip 1 

Assessing your clients’ social environment is as important as their mental and physical health assessment

These classic research studies of the 1970s elevated: 

  • The role of the environment in the development of addiction
  • How addiction affects social problems and vice versa 
  • The importance of considering the family and social environment in treatment.

In the September 2019 edition of TIPS and TOPICS, in SAVVY, I focused on what are social determinants of health. In SKILLS, I wrote of the importance of assessing and including social determinants in treatment planning, not as an afterthought or “discharge planning” task.

The clinical implications of the research encompass:

  • Need for a comprehensive recovery experience that addresses the mental, emotional and social needs of people with addiction, not just their physical needs.
  • Need for an environmental change. A holistic approach to treatment addresses a person’s mental, emotional, social, and spiritual needs, as well as his or her medical and physical needs during substance withdrawal and recovery.
  • Humans do not have to be physically isolated, like the rats in the Skinner Boxes, to become addicted to substances. Emotional isolation is enough to produce the same affects. 
  • Humans cope with their feelings of dislocation with alcohol and other drugs, finding an “escape” or a way to smother the pain. A human’s cage may be invisible, but it is no less there.
  • Humans, not just rats, need to be part of a community, encouraged to relate and experience the support of others. 
  • Ask questions like: Who do you care about in your life? Who cares about you? When was the last time you spent time with people who are good for you-instead of those who hurt you and foster your drug taking? (Lloyd Sederer)

These questions may lead to others, such as: Who can you call or spend time with in the next couple of days? What gives you pause in calling or making the kind of human contact needed to enable recovery? What do you imagine these people would think and feel if you did make contact? How might that encounter go-where it was not about asking for help, or money, but instead simply, and most importantly, about re-igniting their friendship, their attachment to you, and their wish for your life to go well? (Lloyd Sederer).

soul

On December 6, 2021 ASAM News published an article “David Mee-Lee, MD, DFASAM, Named ASAM’s Educator of the Year” (DFASAM means Distinguished Fellow of the American Society of Addiction).

The ASAM Educator of the Year Award recognizes and honors an educator who has made outstanding contributions to ASAM’s addiction medicine education. You can see who else got awards.  Award Recipients will be honored during the ASAM Annual 2022 Conference, in Hollywood Florida.

Of course I felt so honored to be chosen as worthy of such an award. I am gratified that so many have benefitted from my years of training and consulting. I am proud of what I have achieved in reaching thousands of participants in my training work.

But I share this honor with you all because:

  • My career as an educator would go nowhere if there were not participants wanting to learn.  
  • My writing in Tips and Topics would have no resonance if you all Unsubscribed. 
  • My training and consulting would have no impact if participants and systems didn’t apply what they learned and embraced. 

So in that context, I felt in alignment with what an unknown author wrote:

Work for a Cause

Not for applause

Live Life to express

Not to impress

“Pick up a cause in your life and work on it, do it for your own satisfaction and not for the applause or to impress others.”

Then I saw this from AAPI (Asian and Pacific Islander) Women Lead:

I’m not “self made”.  I’m community made.

I’m family made. I’m land made. I’m ancestor made.

I’m made up of everything and everyone 

that made me exist outside just myself.

So as this year ends, and the pace of my career winds down, I thank you for being part of my community, my ‘family’, my land, and everything and everyone outside just me.

November 2021

30th Anniversary of The ASAM Criteria – A Report Card; Two videos I want you to see

Welcome to the November edition of Tips and Topics and a Happy Thanksgiving to all in the USA.

In SAVVY and SKILLS, I take a look at thirty years since the publication of the first edition of The ASAM Criteria. Here is my report card on how the addiction treatment field has implemented the true spirit and content of the Criteria.

In SOUL, I share two videos I saw this month and found so touching. I hope you can find 8 minutes to view them too, especially at this time of Thanksgiving.

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October 2021

It’s not what you do that counts, but who you are; Self care, Personal Mission and Servant Leadership; Sunset of my career.

In SAVVY, my ‘first draft’ on meeting the challenge to write about the mix of spirit and psychology in a book – to articulate the spiritual context that gives structure to the core tools I have trained on full time for 25 years. It can be summarized by a phrase: “It’s not what you do that counts, but who you are.”  

In SKILLS, tips on ‘how to get there from here’ if you are committed to self care, clarity on your personal mission and are ready to be a servant leader.

In SOUL, trying to balance what I do in the sunset of my career to meet the goals of my personal life direction and my professional mission.

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September 2021

National Recovery Month 2021; Understanding Recovery and Recovery Capital; What to say to someone who doesn’t want AA; Katie’s story

In SAVVY, I explore what we mean by Recovery and Recovery Capital.  It isn’t all about abstinence and mental health stability, but rather whole person and whole systems perspectives.

In SKILLS, I focus on how to assess Recovery Capital and also how to approach a person who doesn’t want to go to Alcoholics Anonymous and prefers an alternative support group.

In SOUL, Katie, a person in long-term recovery, shares her recovery story.

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August 2021

Five key principles in helping people change; Skills to implement those principles; Vaccine hesitancy and using the five principles of the Better Arguments Project

In SAVVY and SKILLS, I share the wisdom of Marvin Goldfried, Ph.D. who presented in one paper five key principles on how people change. He wrote about the common principles of change that he distilled from hundreds of schools of thought and approaches to change. For each principle, I offer a few SKILLS to help implement it.

In SOUL, I don’t plan on talking with my daughter and her family about their vaccine hesitancy.  I respect their right to make their own choices.  But in case the topic of vaccines arises, I want to be grounded and centered to know what to say and do. So I used the five principles of the Better Arguments Project to help guide me.

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July 2021

Hard questions in the interface between Treatment and Justice Teams; Scripts on what to say to participants; What’s your Olympic Game?

In SAVVY, I preview a couple of hard questions that New Hampshire Chief Justice Tina Nadeau and I will discuss in the final General Session of RISE21, the National Association of Drug Court Professionals annual conference at the Gaylord National Resort and Convention Center in National Harbor, Maryland.   

In SKILLS, to help convert a clinical principle or policy and procedure into actual words to say to a client, I give some “scripts” of what to say to orient participants in Drug Court; and what to say about positive drug screens.

In SOUL, I have two connections to the Olympic Games and get into the spirit of the Games with my lifelong friends inventing new Olympic games.

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June 2021

Father’s Day, Lessons from 40 years of parenting – a grandfather’s perspective; RULER; Out of the mouths of babes.

In SAVVY, to help children, students and even adults “name their emotions to tame their emotions”, Marc Brackett coined RULER to develop critical and inter-related emotional skills.  Honor your feelings, desires and hopes for your child, but help them learn how to express feelings and needs in a way that fits their temperament and personality, not yours. But there is relief in understanding “good enough parenting”.

In SKILLS, I apply RULER to help parents have a discussion with their children about their feelings, needs and values especially in the context of the family’s values. In the immediacy of the situation, there isn’t time to have a feelings, needs and values discussion.  But in a quiet moment, parents can help their children “become the best them, not the best you.”

In SOUL, “out of the mouth of babes” is when a child says something that surprises you because it seems very wise. My 6 year old granddaughter had one of those moments of wisdom and pointed out that love for each other and arguing are not mutually exclusive.

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May 2021

Overdoses are up, but do we really need just more residential beds?; How to determine initial length of stay and authorization periods; Freddy enters my world.

In SAVVY & STUMP THE SHRINK, is residential care the first priority in responding to the increase in opioid overdoses?  Some States mandate certain periods of time that ban managed care authorizations and requirements for individualized treatment.  I suggest that what we really need in addiction treatment is not just more residential beds and time.

In SKILLS & SYSTEMS, treatment providers and Managed Care Organizations should not be “lined up on different sides of the aisle”.  To determine initial length of stay and authorization periods for an addiction client, think about what you would do for other health conditions.

In SOUL, Fred IV enters my world and joins Siri, Google and my Toyota Prius to help me navigate my cleaning, driving and knowledge worlds.

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April 2021

Rules or Treatment Plans? Relationships and Hooking Up; Getting your head and heart around understanding addiction

In SAVVY, STUMP THE SHRINK & SKILLS, in this combined section, I address co-ed relationships and hooking up while in treatment; Treatment, Rules, or Discharge, not just about these behaviors but also how to address any behavior concerns while in treatment.

In SOUL, I wonder about how hard it is for Justice teams and treatment providers to pivot away from consequences and sanctions for addiction flare-ups; rules and regulations; and compliance and mandates for prosocial behavior. Talk to people in long-term recovery.

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March 2021

Guest writers focus on Problem Gambling Awareness Month; Letting the chips fall where they may

Welcome to the March edition of Tips and Topics and guest writers focused on Gambling in honor of

Problem Gambling Awareness Month

In SAVVY, George Mladenetz informs us about Gambling Treatment Diversion Courts.

In SKILLS, Olubukunola Oyedele, PhD shares results from a small sample study he did on gambling and COVID-19 in New Jersey residents.

In SOUL, I share some natty little phrases that are rich in concept and meaning, but poor in follow through – easy to say, but hard to do.

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February 2021

Two years since I lost my wife; Hope Edelman on “The AfterGrief”; Carrying our loved ones forward; Getting back more than what you lost.

In SAVVY, the history of grief shaped our thinking that grief should be a process to be completed and from which we move on.  Hope Edelman challenges those concepts of grief and speaks of understanding grieving as a lifelong process.

In SKILLS, a couple of tips on how to move forward with grief as a lifelong process.

In SOUL, I share about work, love and play and how you really can get back MORE than what you lost.

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January 2021

Can terminology reduce stigma in opioid addiction? Different terminology for different stigma goals; Facing up to saving and losing face. FaceTime needed.

In SAVVY, a new study researched what terminology would reduce stigma in the prevention and treatment of opioid addiction.

In SKILLS, the choice of terminology may depend on the purpose of communication. Use medical terminology to decrease blame for addiction.  Use non-medical terminology to increase confidence that the person can recover and is not dangerous.

In SOUL, it is not about “losing face” or “saving face” over the Presidential election results.  It’s about “facing up” to “face our problems” and use some “FaceTime” to listen to each other.

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