Progress Made in Understanding Neurobiological Basis for Relapse to Cocaine Abuse
Researchers from the Albert Einstein College of Medicine and NIDA's Intramural Research Program have made a major advance in understanding the neurobiological basis for cocaine abuse relapse. It had been known previously that the learning of associations between environmental cues and taking drugs occurs in the hippocampus and that these cues area major cause of relapse to drug-taking behavior. Now scientists have pinpointed the region(the ventral subiculum area) of the hippocampus and the neurobiological factors (glutamate neurotransmission) that may play an integral role in cocaine abuse relapse.
To arrive at these findings, the researchers first conditioned rats to obtain cocaine by pushing a lever (cocaine-seeking behavior). After this behavior had been well established,saline solution was substituted for cocaine. When the rats no longer received cocaine by pushing the lever, they greatly decreased their lever pushing. The investigators electrically stimulated and injected pharmacological compounds into rats' brains to regenerate cocaine-seeking behavior, and then mapped those brain areas involved in the animals' revived interest in seeking the drug (as measured by increased lever pushing).
- WHAT IT MEANS: The findings from this study suggest that agents based on glutamate are promising candidates as potential medications for cocaine addiction, particularly in preventing environmental cue-induced relapse.
The study is published by lead investigator Dr. Stanislav R. Vorel in the May 11, 2001,issue of Science. It is available online at the journal's Web site http://www.sciencemag.org/. Study of Nearly 60,000 Drug Users Shows that Regular Drug Abuse.
Treatment Coupled with Outpatient Medical Care Helps Cut Hospitalization
Drug users are twice as likely to visit an emergency room and nearly seven times more likely to be hospitalized than comparably aged persons who do not use illicit drugs. Researchers who studied hospitalization rates for nearly 60,000 drug users - almost 20percent of whom were infected with HIV - found that hospitalization rates were lower for those receiving regular outpatient and drug abuse treatment.
The University of Pennsylvania-based researchers looked at the medical and drug treatment services received by 58,243 drug users enrolled in the New York State Medicaid program fromFederal fiscal year 1996 through 1997; 11,556 were infected with HIV. Data were obtained from Medicaid claims for all ambulatory services from physicians, clinics, and drug abuse treatment providers.
Each drug user's pattern of outpatient care based on Medicaid claims in 1996 was categorized as regular drug abuse care only, regular medical care only, both, or neither. Regular drug abuse care was defined as care from a single methadone or drug-free treatment program for at least six contiguous calendar months in 1996. Approximately 40 percent of the study population had regular drug abuse care alone or with regular medical care in 1996, but a higher proportion of HIV+ drug users had regular care of both types.
A regular source of medical care was defined as a clinic or physician visited at least twice as an outpatient during 1996. Over half of the study population had regular medical care. The following year, 1997, more than half (55.6 percent) of the HIV+ group and one-third (37.5 percent) of the HIV- group had at least one hospitalization. Those who were hospitalized spent nearly one month as outpatients over the course of the year. In both groups, those with regular drug abuse care only, or with regular medical care, had the lowest proportions of hospitalization in 1997. For HIV+ drug users, regular drug abuse care coupled with regular medical care was associated with a nearly 25 percent reduction in their predicted rates of hospitalization. Among HIV- drug users, regular drug abuse treatment alone or with regular medical care was associated with more than a 25 percent reduction in predicted rates of hospitalization.
In both groups, the likelihood of hospitalization was greater for persons with drug abuse or medical complications during 1996. Acute alcoholism-related complications were associated with the greatest increase in the likelihood of hospitalization.
- WHAT IT MEANS: Medical and drug abuse treatment in ambulatory services may have substantial benefits beyond reducing medical and drug-abuse related complications. Efforts to promote access to and retention in medical care and drug abuse treatment appear to be attractive strategies for improving the health of this medically complex population.
The study was published by lead investigator Dr. Barbara Turner in the May 9, 2001, issue of the Journal of theAmerican Medical Association. The paper can be viewed online at the journal's Web site http://jama.ama-assn.org/.