Is dropping acid a reasonable way to deal with a drinking problem?
Researchers from the Norwegian University of Science and Technology's department of neuroscience think there's some merit to the idea.
They've gone through data from experiments conducted in the 1960s and 1970s, and say there is evidence that subjects given LSD were more likely to make progress in dealing with a harmful alcohol habit.
Their paper, published in the Journal of Psychopharmacology, took a broad look at six different experimental trials — including one in Canada in 1966 — involving 536 subjects being treated for alcohol problems.
A key finding in this analysis was that, in the trials, 59 per cent of subjects administered a single dose of LSD showed improvements in their alcohol habits in followup assessments months after treatment, compared with 38 per cent of people who did not take the drug.
It's unclear why LSD might have helped people dealing with their drinking, but one of the study's authors, Pal-Orjan Johansen, had this to say: "Many patients claim that they get significant insights into their problems, that they get a new perspective on their problems and motivation to solve them."
He added: "It also seems that some people are prepared to be more self-accepting and able to see negative consequences and happenings in their own lives."
The study found evidence that LSD had a positive influence on the alcohol habits of people out of treatment for as much as six months, but not on those who had been away from a program as long as one year.
Johansen said it's possible LSD could be beneficial in treating other addictions as well, though more research is needed to say that for sure.
Asked whether treating alcohol dependency with LSD could result in replacing one addiction with another, Johansen said: "Psychedelics are not known to be toxic to the body or dependence-producing."
He said that while alcohol and drugs, such as heroin, help users temporarily escape from negativity in their lives, a common view is that LSD brings a person's problems more sharply into focus, creating a much different experience than substances more often linked to addictions.
As to whether long-term psychological problems could arise from using a mind-altering drug, such as LSD, to wean off alcohol, study co-author Teri Krebs said: "Our study, this meta-analysis, is not designed to answer that question."
The analysis did acknowledge negative experiences people can have on LSD, often called "bad trips," but Johansen said: "Anxiety is not dangerous in itself. None of the studies reported lasting psychological problems in any of the LSD patients."
Still, Johansen cautioned that LSD is not necessarily an appropriate answer for everyone dealing with an alcohol addiction, and its usage should involve consultation with a physician.
Donald MacPherson, director of the Canadian Drug Policy Coalition, said it's unclear to him whether LSD is something that should be used to treat alcohol abuse but that it should be looked at.
"We think there should be more research happening in that area," he said. "The drug laws have (created) barriers to doing that kind of research (in Canada)."
Erika Dyck, a professor of medical history at the University of Saskatchewan, said there once were many studies looking at how LSD could be used to treat addiction or psychological problems. That work stopped in the late 1960s in Canada, likely because of legal or supply issues, or a combination of both.
"Part of (past researchers') argument (for the use of LSD) is it functioned like a sped-up psychotherapy, collapsing years of psychotherapy into a single session," she said.
LOUISVILLE, Ky. - Gayle Mink, a nurse practitioner at a community mental health center here, had tired of the constant stream of patients seeking Xanax, an anti-anxiety drug coveted for its swift calming effect.
"It is such a drain on resources," said Ms. Mink, whose employer, Seven Counties Services, serves some 30,000 patients in Louisville and the surrounding region. "You're funneling a great deal of your energy into pacifying, educating, bumping heads with people over Xanax."
Because of the clamor for the drug, and concern over the striking number of overdoses involving Xanax here and across the country, Seven Counties took an unusual step - its doctors stopped writing new prescriptions for Xanax and its generic version, alprazolam, in April and plan to wean patients off it completely by year's end.
The experiment will be closely watched in a state that has wrestled with widespread prescription drug abuse for more than a decade and is grasping for solutions as it claims more lives by the week. While Kentucky and other states have focused largely on narcotic painkiller addiction, experts say that benzodiazepines, the class of sedatives that includes Xanax, are also widely misused or abused, often with grim consequences.
While the patients at Seven Counties are mostly poor, experts say the appeal of Xanax cuts across socioeconomic lines. Alprazolam was the eighth most prescribed drug in the nation last year, according to SDI, a data firm that tracks drug sales. Even more than the figures suggest, Xanax has become part of the popular lexicon, as well known as a panic antidote as Prozac is for depression.
The Centers for Disease Control and Prevention last year reported an 89 percent increase in emergency room visits nationwide related to nonmedical benzodiazepine use between 2004 and 2008. And here in Kentucky, the combination of opiate painkillers and benzodiazepines, especially Xanax, is common in fatal overdoses, according to the state medical examiner.
Seven Counties is not the first health care provider to cut off prescriptions for controlled substances - at least several others around the country have stopped giving patients certain opiates and benzodiazepines - but the practice remains contentious. Some doctors say that refusing to prescribe certain drugs under any circumstance is overly rigid, noting that Xanax helps many people who use it responsibly.
"What they're doing is a noble idea," said Dr. Laurence H. Miller, who heads a committee on public and community psychiatry for the American Psychiatric Association. But he added: "I could never say never to anything. There are some people who may have done very well on it, are on a small dose and manage their lives on it, and that's probably O.K."
But Dr. Scott Hedges, senior vice president for medical services at Seven Counties, said he felt certain that Xanax did not need to be among the options offered there.
"The literature strongly suggests there are lots of really good ways to treat panic and anxiety disorders without using this particular medication," Dr. Hedges said. "And the risk to the community, if we continue to use this medication, is very high."
Xanax poses a particular risk for abuse and withdrawal, doctors say, because its effects are felt almost immediately, but last only a few hours. Users often quickly want more, experts say, and as their tolerance builds, they want increasingly higher doses.
Dr. Hedges said that while Seven Counties bore some blame for prescribing Xanax in the first place, many patients initially got it from primary care doctors. Alprazolam is one of the three most-prescribed controlled substances in Kentucky, along with hydrocodone and oxycodone, according to the state's Cabinet for Health and Family Services.
"We pick these folks up way down the road," said Dr. Robert Caudill, a Seven Counties psychiatrist, "where they're already on a big dose and don't want to give it up because they've been given no skills along the way" for otherwise dealing with panic and anxiety.
For people dependent on opiates, Xanax can be especially alluring because the fear of withdrawing from the opiates is so huge. After someone has experienced opiate withdrawal, Dr. Caudill said, "they really are scared to go into it again because it's so horrible."
"They will panic," he added, "literally."
At Seven Counties, some of the roughly 3,000 patients who were on Xanax have been switched to clonazepam, a longer-acting benzodiazepine that does not kick in as quickly and is thought to pose less risk of addiction.
"They don't get the high that's associated with Xanax," Dr. Hedges said, "nor the withdrawal associated with it."
The eventual goal is to wean patients off clonazepam, too, he said. People with severe anxiety should ideally take an antidepressant as well as a benzodiazepine, he said, and learn coping mechanisms with cognitive behavioral therapy.
The doctors and nurses at Seven Counties have encouraged patients on Xanax to consider these options in addition to clonazepam or instead of it. But the transition has been cautious and slow, Dr. Hedges said, with Xanax doses generally being reduced in half-milligram increments over a number of months.
"It's a very slow and intentional process of weaning down," Dr. Hedges said, "precisely because we don't want to create all this anxiety and panic over, 'Well, I'm not going to get it anymore.' "
After the policy change was announced in March, everyone from the doctors to the receptionists at Seven Counties anticipated some tense moments as patients got used to the idea. It was not lost on them that a doctor in rural eastern Kentucky was shot to death by a patient in 2009 after refusing to prescribe a painkiller.
Indeed, some transitions have been rough. Tina Graham, 44, a Seven Counties patient who suffers debilitating panic attacks, said her anxiety had sharply increased after switching from Xanax to clonazepam this summer. Clonazepam helps for about two hours after taking a pill, but for much of the day, she said, "I'm scared to do anything."
"I'm not saying I have to be back on Xanax," Ms. Graham said. "But if this ain't doing it, something's got to change."
But Dr. Hedges said that such complaints had been relatively few, with about 90 percent of the patients who were taking Xanax already off it.
"We haven't had any episodes of violence, any acting out or difficult behavior in our clinics," he said. "We tried to prepare for that, but in fact it hasn't happened."

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A new American study has found that Ritalin boosts learning by increasing brain plasticity.
Scientists conducted the research on rats to demonstrate, for the first time, that Ritalin boosts the ability to focus on tasks and enhances the speed of learning by increasing the activity of the neurotransmitter dopamine inside the brain.
The study, appearing online in Nature Neuroscience, also showed that one type of dopamine receptor aids the ability to focus, and another type improves the learning itself.
Antonello Bonci, co-senior author of the paper and professor of neurology at UCSF, said:"Since we now know that Ritalin improves behavior through two specific types of neurotransmitter receptors, the finding could help in the development of better targeted drugs, with fewer side effects, to increase focus and learning."
Bonci is also the principal investigator at the Ernest Gallo Clinic and Research Center, which is affiliated with the UCSF Department of Neurology.
Bonci and his team showed that Ritalin's therapeutic action takes place in a brain region called the amygdala, an almond-shaped cluster of neurons known to be critical for learning and emotional memory.
Patricia Janak, co-senior author on the paper, said: "We found that a dopamine receptor, known as the D2 receptor, controls the ability to stay focused on a task - the well-known benefit of Ritalin.
"But we also discovered that another dopamine receptor, D1, underlies learning efficiency."
Janak is a principal investigator at the Gallo Center and a UCSF associate professor of neurology. Lead author of the paper is Kay M. Tye, PhD, a postdoctoral scientist at the Gallo Center when the research was carried out.
The research analysed the ability of rats to learn that they could get a sugar water reward when they received a signal: a flash of light and a sound. The scientists compared the behaviour of animals receiving Ritalin with those that did not receive it, and found those receiving Ritalin learned much better.
But they also discovered that if they blocked the dopamine D1 receptors with drugs, Ritalin was unable to enhance learning. And if they blocked D2 receptors, Ritalin failed to improve focus. The experiments established the distinct role of each of the dopamine receptors in enabling Ritalin to enhance cognitive performance.
Moreover, animals that performed better after Ritalin treatment showed enhanced synaptic plasticity in the amygdala. Enhanced plasticity is essentially increased efficiency of neural transmission. The researchers confirmed this by measuring electrical activity in neurons in the amygdala after Ritalin treatment.
The research confirmed that learning and focus improved when Ritalin was administered to animals in doses comparable to those used therapeutically in children.
Kay Tye said: "Although Ritalin is so frequently prescribed, it induces many brain changes, making it difficult to identify which of those changes improve learning."
"By identifying the brain mechanisms underlying Ritalin's behavioral enhancements, we can better understand the action of Ritalin as well as the properties governing brain plasticity."

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