New research to reduce drug addiction

The Mount Sinai Hospital published on 31 May, 2021 their new research into cocaine addiction using cognitive reappraisal.

In cognitive principle therapy (CPT) we have been using a similar process to control anger, pornography and alcohol addiction for the last 10 years. Their article is shown below, but I have also shown extracts from it in square brackets [ ] below. The CPT approach is discussed:

Step 1- Aware of the trigger

[Relapse in addiction is often precipitated by heightened attention-bias to drug-related cues, which could consist of sights, smells, conversations, anything that reminds someone of their previous drug use]

In pornography addiction, the mental picture starts the excitement phase and the release of dopamine, as shown below.

Step 2- Cognitive reappraisal to address automatic bottom up cue reactivity.

[Through our work and based on the prefrontal cortical mediated benefits of cognitive reappraisal, we have provided a promising framework for self-regulation of automatic bottom-up and very hard to resist drug cue-reactivity]

In CPT we use the "stop, find calm, big picture" technique, The first part (stop, find, calm) is a mantra which switches the sympathetic nerve to the parasympathetic nerve, and creates a new bottom up response of calm from the ventral vagus pathway.

Step 3 -A new Big Picture:

[Cognitive reappraisal is an emotion regulation technique, in which individuals are trained to self-regulate (thereby engaging the prefrontal cortex) the emotional response to a confronted cue or context by reinterpreting its meaning. For example, lines of cocaine in a given picture can be reinterpreted as a movie prop with sugar powder cut in lines to only appear as cocaine.]

A new big picture is created in a different time period [ie. at night]

The cognitive reappraisal causes the predictive mind to follow a different pathway [ie. towards the big picture], rather than to the old habit [ see below]

It starts with the trigger, but it is the combination of the bottom up switch to the "calm nerve" and the change in the comparative-predictive mind's big picture, which causes the change in behaviour.

This technique has been used in reducing anger, pornography and alcohol addiction for the last 10 years, with over 2000 clients of which 70% were mandated to attend. It has mainly focused on anger with most clients reporting substantial reductions after one session. With physical additions, such as alcohol, there is often relapse, but each time it has lower frequency and lower intensity.

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Emotional regulation technique may be effective in disrupting compulsive cocaine addiction

by The Mount Sinai Hospital published 31 May, 2021

An emotion regulation strategy known as cognitive reappraisal helped reduce the typically heightened and habitual attention to drug-related cues and contexts in cocaine-addicted individuals, a study by Mount Sinai researchers has found. In a paper published in PNAS, the team suggested that this form of habit disruption, mediated by the prefrontal cortex (PFC) of the brain, could play an important role in reducing the compulsive drug-seeking behavior and relapse that are the hallmarks, and long-standing challenges, of addiction.

"Relapse in addiction is often precipitated by heightened attention-bias to drug-related cues, which could consist of sights, smells, conversations, anything that reminds someone of their previous drug use," said lead author Muhammad A. Parvaz, Ph.D., Assistant Professor of Psychiatry and Neuroscience, at the Icahn School of Medicine at Mount Sinai, who studies brain-based and behavioral markers that can inform and track addiction treatment and its outcomes. "Our study is the first to suggest that increasing self-regulation of arousal to drug-related cues through cognitive reappraisal could disrupt the brain's automatic attention-bias to these cues, potentially leading to a reduction in compulsive drug-seeking behavior, even outside the lab, in individuals with substance use disorders."

Cocaine is a powerful central nervous system stimulant whose misuse poses serious health risks and side effects. Cocaine addiction is recognized as a treatment-resistant disorder that has reached epidemic proportions nationally and globally. In the United States alone, hundreds of thousands of people are treated in emergency rooms each year following severe (mostly cardiovascular) symptoms associated with use of cocaine. Chronic use of substances of abuse, including cocaine, biases the attentional systems of the brain towards enhanced attention to drug-related cues in the environment (also known as attention-bias), which is considered a risk factor for relapse.

In this study the Mount Sinai researchers postulated that using cognitive reappraisal could disrupt the habitual enhanced attention allocation to drug-related cues in individuals with cocaine use disorder. Cognitive reappraisal is an emotion regulation technique, in which individuals are trained to self-regulate (thereby engaging the prefrontal cortex) the emotional response to a confronted cue or context by reinterpreting its meaning. For example, lines of cocaine in a given picture can be reinterpreted as a movie prop with sugar powder cut in lines to only appear as cocaine. While cognitive appraisal has been employed by prior studies to reduce participants' reactivity to drug cues, Mount Sinai's research is the first to use this emotion regulation technique in individuals with cocaine addiction for its impact on spontaneous (uninstructed and habitual) attention-bias to cocaine-related cues.

"Modification of attention-bias has been a fundamental, albeit elusive, target for relapse reduction over the years," said Dr. Parvaz, who also is Director of the Motivational and Affective Psychopathologies Laboratory at Mount Sinai. "We found that cognitive reappraisal, a function of prefrontal control, decreased spontaneous attention-bias to drug-related cues in people with cocaine addiction. Put another way, increased PFC-mediated cognitive control (of the appraisal process) resulted in enhanced self-regulation of automatic (hard to control) attentional processes in humans with drug addiction."

"Through our work and based on the prefrontal cortical mediated benefits of cognitive reappraisal, we have provided a promising framework for self-regulation of automatic bottom-up and very hard to resist drug cue-reactivity, as potentially generalizable to reduced drug use outside the lab and applicable to addiction to drugs other than cocaine," said Rita Z. Goldstein, Ph.D., Professor of Psychiatry and Neuroscience, and Chief of the Neuropsychoimaging of Addiction and Related Conditions research program, at Mount Sinai, and senior author of the paper. "With further research, we think these results could contribute to the development of a readily deployable cognitive behavioral and personalized intervention strategy, to be used by those who battle drug addiction. Contributing to the development of empirically-validated neuroscience-based interventions for drug addiction has been an important goal in our lab."