The dopaminergic system, and in particular the dopamine D2 receptor, has been implicated in reward mechanisms. The net effect of neurotransmitter interaction at the mesolimbic brain region induces “reward” when dopamine (DA) is released from the neuron at the nucleus accumbens and interacts with a dopamine D2 receptor. “The reward cascade” involves the release of serotonin, which in turn at the hypothalmus stimulates enkephalin, which in turn inhibits GABA at the substania nigra, which in turn fine tunes the amount of DA released at the nucleus accumbens or “reward site.” It is well known that under normal conditions in the reward site DA works to maintain our normal drives. In fact, DA has become to be known as the “pleasure molecule” and/or the “antistress molecule.” When DA is released into the synapse, it stimulates a number a DA receptors (D1-D5) which results in increased feelings of well-being and stress reduction. A consensus of the literature suggests that when there is a dysfunction in ...

Reward deficiency syndrome: a biogenetic model for the diagnosis and treatment of impulsive, addictive, and compulsive behaviors.

The effectiveness of drug abuse treatment: a meta-analysis of comparison group studies.

Despite the widespread use of psychotherapy for patients with substance use disorders, the effectiveness of psychotherapists conducting such treatment has received little research attention. In this paper, empirical studies of therapists' differences in patient outcome and dropout rates are comprehensively reviewed. The main conclusions are that therapists show diverse rates of effectiveness, and that such differences appear independent of both therapists' professional background and of patient factors at the start of therapy. The primary therapist characteristic thus far associated with higher effectiveness is the possession of strong interpersonal skills. Guidelines for research on therapist effectiveness are presented.

Variations in therapist effectiveness in the treatment of patients with substance use disorders: an empirical review

This article reviews claims for methodological innovation in qualitative research. It comprises a review of 57 papers published between 2000–9 in which claims to innovation in qualitative methods have been made. These papers encompass creative methods, narrative methods, mixed methods, online/e-research methods, focus groups and software tools. The majority of claims of innovation are made for new methods or designs, with the remainder claiming adaptations or adoption of existing methodological innovations. However, the evidence provided of wholly new methodologies or designs was limited, and in several papers such claims turned out to relate either to adaptations to existing methods, or to the transfer and adaptation of methods from other disciplines, primarily from arts and humanities. We argue that over-claiming innovation in the sense of the development of a wholly new methodology or design has a number of important implications that are potentially detrimental to qualitative social science.

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Innovation in qualitative research methods: a narrative review

Background Partly because of a lack of a conventional, effective treatment for cocaine addiction, auricular acupuncture is used to treat this disorder in numerous drug treatment facilities across the country for both primary cocaine-dependent and opiate-dependent populations. Objective To evaluate the effectiveness of auricular acupuncture for the treatment of cocaine addiction. Methods Eighty-two cocaine-dependent, methadone-maintained patients were randomly assigned to 1 of 3 conditions: auricular acupuncture, a needle-insertion control condition, or a no-needle relaxation control. Treatment sessions were provided 5 times weekly for 8 weeks. The primary outcome was cocaine use assessed by 3-times-weekly urine toxicology screens. Results Longitudinal analysis of the urine data for the intent-to-treat sample showed that patients assigned to acupuncture were significantly more likely to provide cocaine-negative urine samples relative to both the relaxation control (odds ratio, 3.41; 95% confidence interval, 1.33-8.72;P= .01) and the needle-insertion control (odds ratio, 2.40; 95% confidence interval, 1.00-5.75;P= .05). Conclusions Findings from the current study suggest that acupuncture shows promise for the treatment of cocaine dependence. Further investigation of this treatment modality appears to be warranted.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/746723/ioi90746.pdf

A Randomized Controlled Trial of Auricular Acupuncture for Cocaine Dependence

This article explores countertransferential and attitudinal considerations in relation to their impact on the evaluation, diagnosis, and therapeutic management of drug-dependent individuals. Following a literature survey of the manner in which countertransference has been applied to the treatment of drug dependency, the authors discuss the status of the drug-dependent individual as a psychiatric patient and the resultant treatment implications when such a patient is viewed from within, rather than exclusive of, the mental health treatment delivery system. A number of examples are provided of patient-induced countertransferential reactions, in addition to specific attitudinal factors often present in the treatment of addiction.

John Imhof

Papers

Countertransferential and Attitudinal Considerations in the Treatment of Drug Abuse and Addiction

Is auricular acupuncture beneficial in the inpatient treatment of substance-abusing patients? A pilot study

Countertransferential and attitudinal considerations in the treatment of drug abuse and addiction

A Family Therapy Approach to the Treatment of Drug Addiction

Treatment protocol effectiveness study A white paper of the office of national drug control policy Barry R. McCaffrey, Director March, 1996