According to the National Institute on Drug Abuse, approximately 570,000 people die each year due to drug use, along with more than $700 billion in increased health-care expenditures, lost productivity, and costs associated with drug-related criminal activity.
Behind these sobering statistics lie countless lives ruined and hearts broken. But for both addicts and their families, argues UNLV’s Daniel Allen in a new book, recent research offers promise for treating this troubling — and enduring — problem.
Co-edited with Steven Paul Woods of the University of California, San Diego, Allen’s Neuropsychological Aspects of Substance Use Disorders: Evidence-Based Perspective includes work by some of the world’s most distinguished addiction researchers.
“Our hope is that our book will help address some of the obstacles to understanding and treating substance use disorders by bringing together the most current information from the brain science literature with application to specific substances of abuse and special populations,” says Allen, UNLV’s Lincy Professor of Psychology and a former president of the National Academy of Neuropsychology.
The project sprang from what Allen and Woods say was an “obvious gap in the literature on neuropsychology and substance abuse.”
“There have been so many new developments increasing our understanding of substance abuse from a brain perspective,” says Allen. “There was a real need for a book where the most up-to-date information is assembled.”
After identifying the need, Allen and Woods recruited an international dream team of brain science leaders to contribute chapters. Authors include such nationally recognized experts as Warren Bickel, director of the Addictions Recovery Research Center at Virginia Tech; John Crabbe, director of the Portland Alcohol Research Center at the Oregon Health & Science University; and Igor Grant, director of the HIV Neurobehavioral Research Program at the University of California, San Diego.
“As I was editing some of the chapters that came in, I found myself learning much in areas that are not a central part of my own research program,” Allen says. “There are so many new developments with the knowledge base increasing each day; having an opportunity to read about the most current findings was rewarding. And it was also rewarding to have the opportunity to interact with some of the brilliant scientists doing the research.”
Substantial progress has been made, he adds, from the days when alcoholism and substance use problems were viewed as moral failings. Today’s researchers instead view them as clinical challenges, disorders demanding empirical investigations aimed at discovering successful psycho-logical and pharmacological treatments.
Allen is upbeat about what’s been accomplished so far, but says much work remains to be done.
“In particular, interventions for substance use disorders are not as effective as we would like, and understanding the interactions between treatment effectiveness and individual variables such as ethnicity, comorbid mental and physical illnesses, and cognitive disorders continues to present challenges to researchers and clinicians,” he says. (“Comorbid” is a term that describes patients who have two chronic diseases or conditions simultaneously.)
Allen adds that the interplay between environmental and genetic contributions to the development and continuation of substance use disorders requires more study, as does identification of those who are at the greatest risk of developing problematic patterns of substance use.
The book is grouped into three sections. The first focuses on new developments in the fundamental science, such as genetic influences and neural substrates of addiction. The second addresses recent research from each of the major categories of substances typically abused. The third deals with special patient populations and topics, including patients whose substance-use disorders occur with comorbidities, such as infectious disease, traumatic brain injury, and, especially, mental illness.
“Serious mental illness and substance abuse comorbidity continues to be a significant challenge to the treatment community,” he says. “Unfortunately, those with mental illness and comorbid substance abuse probably make up the majority of individuals who have schizophrenia and bipolar disorder, but we know less about them than we do about those without substance abuse disorders.”
Allen gravitated toward addiction treatment while specializing in the neuropsychology of mental illness at a Veteran’s Administration hospital in Pittsburgh, where he worked before joining the UNLV faculty in 1999.
“The biggest problem I saw among vets I worked with by far was substance use disorders, particularly alcoholism and cocaine use,” he says. “I found it hard to provide adequate treatment for them because, at the time, little information was available in the empirical and clinical literature that specifically addressed the unique needs of individuals with both a mental illness and a substance use disorder.”
Allen’s hope for the book is that it might help clinicians, researchers, and graduate students overcome barriers to understanding the complex set of neurological factors at play in substance use disorders.
“Ideally, it’s a book that can be a reference tool for those who want to review a summary of recent literature from a group of nationally respected experts,” he says. “I hope that clinicians and the academic community find it useful and can turn to it when they seek the most up-to-date research in this area of study.”
