PLENARIES 2016
P1: Drug Abuse and Addiction Research
Dr. Nora Volkow, USA
NIDA
Nora D. Volkow, M.D.
Director
National Institute on Drug Abuse
National Institutes of Health
Recent scientific advances have increased our understanding of the biological, developmental, and environmental factors involved in drug abuse and addiction and are stimulating further explorations into increasingly targeted strategies for their prevention and treatment. This presentation will highlight a selection of recent scientific advances, provide an update on a number of relevant policy and research initiatives currently being supported by the National Institutes of Health and the National Institute on Drug Abuse, and describe some of the most pressing challenges currently confronting the drug abuse and addiction field and solutions that show promise in effectively addressing them.
Learning Objectives:
Attendance at this presentation will increase participants’ awareness of:
1. Illustrative examples of recent research advances in the science of addiction.
2. Current and emerging opportunities for research in drug abuse and addiction related areas both at NIDA and at the NIH.
3. Several of the most pressing challenges currently facing the drug abuse and addiction field and steps being taken to address them.
P2: ALICE RAP – over 200 scientists, 21 projects, 5 years of research on psychoactive substances and gambling prevention and policies: Lessons learned?
Jürgen REHM
Centre for Addiction and Mental Health (CAMH); 33 Russell Street; Toronto, Ontario, Canada M5S 2S1
ALICE RAP was an EU funded large project to reframe addictions, winning a special competition on reframing addictions. Its results has been summarized in a series of five books of Oxford University Press (see Anderson et al., 2016 for a final summary of all findings), numerous peer-reviewed journal articles, and a series of policy briefs (http://www.alicerap.eu/ ). We will give a succinct overview of main results and then discuss parameters of success, in particular, whether the project achieved what is was set out to do, namely achieve a reframing of addictions in Europe. We will separate three dimensions of impact: a) the academic discourse, b) impact on funder and European Union bodies, and c) wider impact on the debate of substance use policies; and present empirical indicators of dissemination up to September 2016.
Anderson, P., Braddick, F., Conrod, P., Gual, A., Hellman, M., Matrai, S., Miller, D., Nutt, D., Rehm, J., Reynolds, J. & Ysa, T. (2016). The new governance of addictive substances and behaviours. Oxford, U.K.: Oxford University Press.
Learning Objectives:
1. Ability to state the primary challenges for establishing/changing substance use policies in 2016
2. Ability to name the opportunities and challenges for the role of research in establishing/changing substance use policies
P3: Candidate gene association approaches in cannabis use disorder
Dr. Amine Benyamina
Hôpital Paul Brousse 12 Avenue Paul-Vaillant-Couturier 94800 Villejuif
Numerous studies have shown that addictions and psychiatric disorders have a significant genetic and environmental basis. Genetic research in cannabis addiction has been advancing over the past decade. Recent genome-wide association studies have revealed a few potential candidate genes. Other candidate genes have been investigated through hypothesis-driven research. The objective of this presentation is to show the current theoretical framework for candidate gene investigations. We will then show some of the results from our own genetic association studies in a population of cannabis dependent patients without any significant psychiatric comorbidities. Our studies examine the potential influence of the ABCB1 gene on cannabis pharmacokinetics which could play a role in the genesis of cannabis use disorder. Another examines interactions between clock gene polymorphisms which influence biological rhythms and environmental factors leading to sleep disturbances which could increase vulnerability to cannabis use disorder. This research could lead to improved clinical management and novel future therapeutic approaches in treating cannabis withdrawal and cannabis use disorder.
Learning Objectives:
1. Describe current research approaches to candidate genes in addictions
2 Show that these approaches have begun to show some promising results which may have future clinical implications
P4: The promise of a cure: taking advantage of Hepatitis C care to reach out and improve the health and wellbeing of persons who inject drugs
Julie Bruneau
900 rue Saint-Denis, Montreal, QC, H2X 0A9
The economic, health and social consequences of drug use disorders are devastating worldwide. Injection drug use is a major public health concern as it is, nowadays, the main factor contributing to hepatitis C virus (HCV) transmission worldwide. Timely HCV detection and a combination of harm reduction interventions are required to reduce HCV transmission among PWID, albeit not enough to achieve elimination.
Significant decreases in HCV incidence and prevalence and in the corresponding disease burden can only be accomplished by reducing transmission rates among high-risk persons and enhancing treatment access for those at the greatest risk of disease progression or of transmitting the infection.
Compounding the health impacts of drug use and HCV disease are the myriad of other adverse health outcomes faced by PWID. It is imperative to better assess and intervene on barriers to linkage and engagement in care. Enhanced HCV care and treatment could also lead to more appropriate health services and improved health outcomes, including for addiction and mental health.
In this new era of short all-oral effective direct acting antiviral HCV treatments, there is a unique opportunity to focus on the needs of persons with drug use disorders while in treatment, to achieve HCV cure, reduce HCV reinfection rates and overdose deaths.
This presentation will discuss individual-centered and systemic approaches for bridging addiction, HCV and primary care disciplines in order to address the health and wellbeing of drug users, and reduce the health and social burden associated with these syndemic epidemics.
Learning Objectives:
1. To review strategies and interventions aimed at improving health outcomes among people who inject drugs.
2. To discuss HCV treatment as an opportunity to improve health outcomes for people who inject drugs and their partners.
P5: The Relationship Between Stress and Addictions: The Impact of Gender and Childhood Trauma
Kathleen T Brady, MD, PhD
Medical University of South Carolina, 125 Doughty Street, Suite 140, Charleston, SC 29403
Email:
The relationship between stress, stressful life events and addictions is complex and not unidirectional. Early childhood stressors can lead to a vulnerability to the development of substance use disorders and stressful life events can lead to relapse in individuals in recovery. In addition, individuals with addictions can display poor judgement which places them at risk for exposure to trauma. One of the overarching issues is the neurobiologic connection between stress and SUD’s. The rapid development of technical advances in the neurosciences has led to increased understanding of overlapping molecular biology, neurotransmitter systems and neural circuitry involved in both the stress response and addictions. There appear to be gender differences in the connection between addictions and stress. The focus of this presentation is on the neurobiologic interface of stress and substance use disorders with an emphasis on emerging data concerning gender differences in this relationship. Better understanding of the connection between stress and addictions could have a profound impact on prevention and treatment.
Learning Objectives:
1. To learn about similar neurobiologic systems activated with chronic stress and chronic substance abuse.
2. To learn about the neurobiologic basis for gender differences in the connections between stress and relapse to substance use disorders.
3. To learn about potential mechanisms underlying the connection between childhood adversity and the development of substance use disorders.
P6: Social Support as a Modality for Promoting Abstinence: Clinical and Biological Mechanisms.
Gregory Bunt, MD & Marc Galanter, MD
The capacity of group influence to establish and sustain abstinence in persons addicted to alcohol and other drugs is now well established. Mechanisms underlying the modalities that employ such influence need to be clarified for optimal medical addiction practice, where emphasis is generally focused on pharmacologic and behavioral interventions, rather than social modalities. The objective of this session is to clarify these mechanisms and to illustrate how they have been applied in two different contexts. Two examples will be elaborated on how social support mechanisms have, in practice, been institutionalized to stabilize and sustain abstinence. The talks will provide a research background on these mechanisms, and provide attendees with a basis for optimally employing these modalities in clinical practice. The first modality is that of the drug-free therapeutic community, employed worldwide in different national adaptations. An example elaborated is that of Daytop Village, a network of programs with both residential and ambulatory components. In this modality, the community itself is the therapeutic instrument. The second modality is that of Twelve Step programs, Alcoholics Anonymous and Narcotics Anonymous, that wed mutual support among members to a spiritual orientation. Here a strongly espoused ideology acts to support the influence of group membership. An example will be provided of neural correlates of AA ritual in generating decreased responsivity to alcohol triggers.
Learning Objectives
1.To understand mechanisms underlying how therapeutic communities and Twelve Step groups achieve their therapeutic effect.
2.To improve skills in employing these modalities in clinical practice.
3.To integrate knowledge of the biology of social support into models of addiction and recovery.
P7: Dual Diagnosis
Pedro Ruiz, MD
843 Longview Drive, Sugar Land Texas 77478 USA
This presentation will primarily focus on the current view and perspective of "dual Diagnosis" across the world, and its impact in the understanding of the integrated management and care of addictive disorders and concomitant mental disorders and conditions all over the world.
In this respect, we have to underline thatthe "dual disorders" concept is now days extended to all sectors within the field of psychiatric disorders and conditions. It is certainly present among persons suffering from depression, pain, personality disorders, certainly among patients who suffer from all types of coexisting substances of abuse, and all types of psychiatric disorders and conditions.
Not only the concept of dual disorders can extend to all psychiatric diagnosis and/or conditions, but also to all ages as well; for instance, it is observed among the youth, as well as the middle aged and the elderly. Additionally, it is also observednot only in men but in women as well. Given the extended presence in the mental health field and among the mental health population at large,it is imperative that we addressed them duallyor jointly.
Now days, this dual concept of mental illness and substances of abuse is permitting to view both conditions from a medical point of view and also offering appropriate care and positive solutions for both illnesses and/or conditions.
Hopefully, this presentation and discussion will lead to new perspectives vis-a-vis the care of both conditions; that is, psychiatric illnesses and addiction.
Learning Objectives:
1. Improve the understanding of dual diagnosis
2. Enhance the treatment of dual pathology
P8: Cannabis:Prescribe, Control, Ban or Set Free? How and Why?
Harold Kalant, MD, PhD, FRSC
Dept. of Pharmacology & Toxicology, Medical Sciences Bldg., University of Toronto, 1 Kings College Circle, Toronto, ON, M5S 1A8
Approved medical indications for cannabis or Δ9-THC are still widely limited to relief of neurogenic pain, nausea and vomiting due to chemotherapy, and appetite stimulation in AIDS and cancer patients. Newer studies provide fairly good evidence of usefulness in epilepsy, multiple sclerosis, Crohn’s disease, various sleep disorders, and possibly psychosis. However, much of this evidence relates to CBD, which is free of unwanted psychoactivity seen with THC or cannabis. Several other claimed therapeutic uses still lack sufficient evidence in humans or are rejected by clinical experience. Cannabis is not the best drug for any indication because its low selectivity carries high risk of adverse side effects. More selective developments are most likely to come from highly specific modulators of different components of the endocannabinoid system.
Non-medical use is typically at much higher doses of THC, and adverse effects are common, especially in adolescents and young adults. There is growing pressure for abandonment of prohibition, because of harm to those acquiring criminal records solely for possession for personal use, but there is need to prevent access to cannabis by youth. Selecting the best policy option requires accurate knowledge of the magnitude of problems caused both by cannabis and by the law, and the probable effects on both by each option. Much of this information is not yet available. The most rational approach is therefore to decriminalize possession now, closely monitor consequences of legalization where it is already being tried, and defer decision on legalization until the necessary information is available.
Learning Objectives:
1. Recent knowledge about therapeutic uses of cannabis, cannabinoids and endocannabinoid system modulators
2 Scientific knowledge required for rational policy formulation on nonmedical use of cannabis
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