Insights and treatments

Almost a decade ago the University of Arkansas for Medical Sciences (UAMS) opened its new Center for Addiction Research and installed Dr. Warren Bickel as its director.

Dr. Bickel, a professor of psychiatry and behavioral sciences, had experience in examining the behavioral processes that underlie drug dependence and had conducted research examining novel cost effective ways to deliver treatment.

Alison Oliveto, a colleague of Bickel’s and a professor and vice chairman of research in psychiatry and behavioral sciences at the University as well as a senior scientist for the Center, was working on studies dealing with the pharmacology of drugs of abuse and how different medications can provide relief.

While on the research faculty at Yale, Oliveto helped test and develop medications like suboxone for the treatment of substance abuse.

Both have moved on in the normal course of things, but shortly after he arrived, I interviewed Dr. Bickel, and he pulled the curtain back on some of the projects the Center was working on aimed at helping more people recover from addictions at less cost.  Much of his work of his work I found to be insightful and even entertaining to contemplate.

One project was “computer-based therapy,” which was designed to give participants help with their recovery wherever they are. During a test at the Treatment Center, computer-based therapy participants first give a urine sample, and then, based on their answers to questions about their abstinence or lack of it, the computer provided facts and words of encouragement about recovery.

More needs then therapists

At the time, Dr. Bickel reminded skeptics that “we have more needs than we have therapists, and we have to leverage counseling time.”

Computers, Bickel added, “also have the virtue of being infinitely patient,” a significant benefit when treating someone in deep denial. The computer doesn’t give up.

Another subject that interested Bickel was that “drug dependent people don’t think much about the future. Studies show that heroin addicts think ahead an average of 9 days, he said, while the time horizon for the general population is four and a half to seven years hence.

“If you are only thinking a day ahead,” Bickel says, “it allows you to make choices that completely ignore the consequences of some of your decisions.”

Studies of the brain, Bickel said, also show that the cerebral cortex, which provides the capacity to plan and think abstractly, among other things, “goes offline with addicts, and they go back to the more primitive part of the brain dealing mostly with emotions—the limbic.”

The findings seemed to confirm what the average citizen believes about the behavior of alcoholics and other drug users. It also suggested that getting the cortex back on line and toning down the limbic are worthy goals in substance abuse treatment.

Abstinence works

One other point Bickel made was that“abstinence works.” Center researchers, he says, use “contingency management” which is a motivational technique designed to promote abstinence.

“We find something that they value—and give it to them when they are abstinent, and that helps to move them to continue to be abstinent,” Bickel said.

Bickel’s goal of extending the benefits of recovery to more people at the lowest possible cost is a promising addition to the treatment of addictions which had its first major breakthrough over 80 years ago.

That’s when Bill Wilson, a stockbroker, and “Dr. Bob” Smith, a physician, founded Alcoholics Anonymous, which was based partially on their discovery that one alcoholic talking to another coupled with a spiritual experience produced significant change.

Since that time, millions have sobered up following the AA 12-step program, a result that the late psychiatrist Dr. Scott Peck characterized as one of the top two significant events of the 20th century. The other was World War II.

This brings us to Jennifer who suffered from feelings of anxiety and mild depression and was treating it with the prescription drug Vicodin. She had stopped drinking and was attending AA meetings but  her Vicodin drug habit persisted and consumed most of her waking hours.

“Eventually,” she said, “your habit manages you and not the other way around.”

That’s when she saw the UAMS ad.

In the detox phase, Jennifer chose to cut her use of Vicodin abruptly from 12 pills a day to nothing in two days instead of tapering off more gradually.

“I wanted to feel it, and I wanted to remember it,” she said.

The withdrawal was a tough 48 hours with sick flu-like symptoms, severe headaches, crying and suicidal thoughts.

On the third day, when she was vicodin free, she began taking the suboxone which she picked up every morning at the clinic. She took one

dose in the morning and one in the afternoon on her first day, and, she says, “I felt normal.”

After that first day, she tapered off on the size and frequency of her suboxen doses until she was drug free.

Her program of recovery further required that she meet with a counselor once a week, attend a group meeting twice a week at the clinic and attend an outside meeting — AA or NA — once a week.

UAMS special facilities and disciplines

Special facilities and disciplines at UMAS include:

The Helen L. Porter and James T. Dyke Brain Imaging Research Center which is exploring the most complex and least understood organ in the human body to gain a better understanding of the causes of mental illness and specific brain responses to medication and behavioral therapies.

The Center for Addiction Research (CAR) conducts studies of those addicted to drugs, what makes them tick and how to treat them.

The Child and Adolescent Psychiatry division treats Arkansas’ youngest patients, many of whom are barely old enough to speak, much less understand the problems they have at home and in school.

The Division of Health Services Research (DHSR) is a team of faculty and post-doctoral fellows who conduct scientific studies in the areas of mental health and substance abuse..

The Precision Medicine Program at the Psychiatric Research Institute is a referral program for personalized evaluation and precision treatment of depression. This may include electroconvulsive therapy and transcranial magnetic stimulation.

The PRI Trauma Center focuses on psychiatric and psychological services for children, adolescents and families. Clinicians and psychiatrists are trained in treating children who have faced the most traumatic events, such as sexual or physical abuse, witnessing of domestic violence or death, and long-term maltreatment.

The Women’s Mental Health Program specializes in providing care to women who are planning a pregnancy, are currently pregnant or who are postpartum and have either mental-health or substance-abuse issues.

 

 

 

 

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