Addiction is a physical and psychological dependence on a substance such as alcohol, marijuana or tobacco. But addiction can also include dependence on experiences like gambling or using the Internet. Experts say that a person crosses the line into addiction when use of the substance or pursuit of the experience causes medical problems or interferes with daily life functioning, including employment, marriage, family life, or legal or financial status.

Addiction wrecks lives. Alcohol abuse alone plays a role in at least 10,000 teen deaths in the United States each year, according to the Centers for Disease Control and Prevention (CDC). Internet abuse on the job, such as shopping or playing games, accounts for millions of dollars lost from businesses as employees use workplace computers for leisure pursuits. American business lost an estimated $81 billion in productivity in a single year, with $37 billion from premature death and $44 billion due to illness, as a result of alcohol and drug use, according to a U.S. Department of Health and Human Services (DHHS) report.

UConn researchers are helping to discover new and better ways to treat all types of addictions with strategies that include cognitive behavioral therapies and medication. UConn was one of the first institutions in the United States to start an alcohol research center and is responsible for a number of significant contributions to the field. Researchers are also conducting clinical trials on treatments for smoking cessation, marijuana use and compulsive gambling, among others. The specific   causes of addiction are unknown, but genetic factors appear to be part of the answer. UConn researchers are working to identify the genes linked to the susceptibility to alcohol and drug dependence.

The 2002-03 National Survey on Drug Use and Health for DHHS found that 8 percent of all Americans say they use illegal drugs, 30 percent say they use tobacco products and at least half of all Americans say they regularly consume alcohol. Most of this potentially addictive behavior occurs among individuals between the ages of 18 and 25 years old.

SMOKING
Smoking claims more lives than any other addiction, according to a 2003 Harvard School of Public Health study published in The Lancet. Tobacco use is the leading preventable cause of death in the United States, claiming 430,000 Americans each year. An estimated $80 billion of total U.S. health care costs each year is attributable to smoking, says the National Institute on Drug Abuse (NIDA). Of all the addictions, smoking is usually the hardest to stop, says researcher Cheryl Oncken, an internist and associate professor of medicine at the UConn School of Medicine.

“It often takes three to five serious attempts to quit,” says Oncken. “Within 24 hours, smokers get withdrawal symptoms, including a craving for cigarettes, difficulty with sleep or concentration. People then smoke to relieve withdrawal.”

Oncken is now studying a new non-nicotine drug, to see whether it is as effective as a nicotine patch. Varenicline is a non-nicotine drug that sits on the nicotine receptor and fools the brain into thinking that nicotine is there. Through a unique mode of action the drug stimulates the brain’s nicotine receptors just enough to eliminate the satisfaction of smoking while preventing withdrawal symptoms. However the drug itself is not addictive. Now with the drug midway through clinical trials, Oncken is trying to determine the best dosage level of Varenicline for use in smoking cessation treatment.

Oncken and her team are also studying smoking cessation in pregnant women and the relationship between osteoporosis and smoking.

Like many, Diana Smith started smoking at age 12 because she thought it was cool. She kept smoking off and on through the years to stay slim and keep calm. Now 40 years old, the Terryville, Conn., resident tried to quit a pack-and-a-half a day habit several times.

“I couldn’t quit no matter what; I   was just addicted,” Smith recalls. “If I stopped smoking I became a nasty, hateful person so I always started up again. I used to walk the dog just so I could hide and have a cigarette.” Smith learned about a UConn smoking cessation study and enrolled in April. She was given nicotine patches and weekly counseling, and has not smoked since. The study, which is ongoing, compares smoking cessation in patients who are using nicotine patches to a group taking Varenicline.

“Understanding why Diana was able to quit this time is complicated,” says Janet Pinto, a UConn research nurse coordinator. “Part of the solution is having to answer to somebody about whether or not you are smoking. She had to be motivated.”

ALCOHOL
For many years, most alcoholics have been treated with support groups like Alcoholics Anonymous or sessions with psychotherapy focused on treating the underlying motives for drinking. UConn researchers are using two new approaches to treat alcoholism—drug therapies and contingency management.

“Developing medications to treat alcohol dependence is an area that’s likely to become more prominent,” says Henry Kranzler, professor of psychiatry and an investigator at UConn’s Alcohol Research Center. Given the potential to improve outcomes from psychosocial treatments, Kranzler thinks that clinicians should routinely consider the use of medications to treat alcohol dependence.

There are currently three drugs approved for the treatment of alcohol dependence: disulfiram, naltrexone and acamprosate. Kranzler and colleagues have done extensive research on the effectiveness of naltrexone, an opiate blocker used to treat both alcohol and opiate dependence. The oldest drug, disulfiram, acts as a deterrent against drinking by causing nausea and vomiting when alcohol is consumed. The newest medication, acamprosate, was approved in the U.S. after more than a decade of widespread use in Europe. Prescriptions for acamprostate have already outstripped the modest level of prescribing for disulfiram and naltrexone, Kranzler says.

Despite such evidence, medication is not widely used in treating alcoholism. But Kranzler expects that to change once the drugs are marketed more aggressively. The need is evident, as the National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimates that one out of 13 adults in the U.S., or nearly 14 million people, is alcohol dependent or abuses it at a cost of $185 billion per year to the economy in work and family life.

Contingency management operates on the principle that if behavior is reinforced or rewarded, it is more likely to be repeated in the future. Patients are offered prizes, such as vouchers for movies for abstaining from alcohol. One UConn study conducted by Nancy Petry, associate professor of psychiatry, showed that nearly 85 percent of those who had the opportunity to win prizes were successful in completing an abstinence program, but only 22 percent were successful without the incentives. These behavioral treatments can be applied either in conjunction with standard psychotherapies or with pharmacotherapies.                         

MARIJUANA
Thinking that marijuana is not an addictive drug is a popular misconception. The National Institute on Drug Abuse says 280,000 people who entered drug rehabilitation programs in 2002 did so for marijuana addiction.

“In our research, people who smoke two to three joints a day become physically and emotionally dependent on it,” says Ron Kadden, UConn professor of psychiatry and a drug researcher. “Dependence on marijuana takes much longer to develop than dependence on heroin or cocaine, but once dependence does develop it’s very difficult to achieve abstinence.”

There is a strong psychological factor with marijuana use. The person who is dependent develops a new equilibrium and does not believe he can function adequately without it, Kadden says.

“It leads people to stop paying attention to work and family—they are living for their drugs,” says Kadden, who conducted a recent study that found chronic cannibis users were better able to stop using the drug after cognitive behavior therapy was combined with motivational therapy.

In a multi-center marijuana study, Kadden compared two different treatments to see whether patients who abused or were dependent upon marijuana would reduce their use or abstain entirely. He found that when patients were offered multiple sessions of multi-component therapy, there was a greater reduction in marijuana use than in fewer, less diverse sessions.  

GAMBLING
A 2005 study by Canadian researchers published in the journal Alcoholism: Clinical & Experimental Research found that gamblers face stronger addictions than alcoholics. The National Academy of Sciences says more than 70 percent of youngsters between the ages of 10 and 17 gamble, with nearly one of three high school students gambling on a regular basis.

Up to 5 percent of the general population will develop a gambling problem at some point in life, says UConn’s Nancy Petry, who is conducting the country’s first National Institutes of Health-sponsored study of treatment options for pathological gamblers. She is also studying heavy gamblers who spend more time or money than they intend to spend on gambling, but who have not yet experienced severe family, social or financial problems.

“For pathological or compulsive gamblers, we are studying the efficacy of three types of psychotherapy for reducing gambling,” Petry says.

Each intervention involves eight weeks of individual psychotherapy. Two of the interventions are based upon cognitive behavioral therapy, with one of them also including aspects of contingency management. These patients receive incentives for practicing what they learn in the sessions and becoming involved with other social or recreational activities that do not involve gambling. The third treatment is a more common psychotherapy that focuses on assisting patients to better understand their gambling and getting assistance with other problem areas.

“We are trying to determine which treatments work best for pathological gamblers in general and if certain types of gamblers respond better to the different interventions,” Petry says. “So far the treatments have been very successful in helping most of the gamblers substantially reduce gambling, if not stop completely.”

Heavy, non-pathological gamblers usually do not want to consider gambling abstinence because they have not experienced severe problems, so Petry makes suggestions about how to minimize their gambling losses, such as not bringing extra money or borrowing it. She says she tries to get the person to recognize patterns and situations that lead to gambling, encouraging them to expand other recreational activities that do not involve gambling.

“We are comparing four types of very brief interventions, ranging from a single five-minute session to four sessions in duration, for these gamblers. These brief interventions are having a very pronounced effect in decreasing the amounts of money spent gambling,” she says.

INTERNET
Research shows that about 6 percent of people using the Internet have become addicted to it, says Dave Greenfield, a psychologist and assistant clinical professor at UConn, who conducted one of the first studies on Internet addiction. In the United States, 202.8 million people use the Internet, almost 70 percent of the population, according to the Web site, Internet World Stats. com. Worldwide, Internet use is 938.7 million people with international growth 160 percent from 2000 to 2005.

“I’ve seen young men and teenagers who are spending six, eight, 10, up to 14 hours a day at the computer,” Greenfield says. “They’re playing computer games, eating their meals and even urinating into a bucket at the computer. It’s having a significant negative impact on their lives. Most people don’t realize the Internet can be addictive.”

First identified six years ago, Internet addiction is more insidious than other addictions because the computer is associated with efficiency, education and work. But like any addictive substance, the Internet can alter mood and consciousness, causing individuals to enjoy the experience, Greenfield explains.

Greenfield says treatment for Internet addiction is similar to treatments for all other addictions in which the cycle of use is broken to try and find the underlying reason—depression, anxiety or relationship difficulties—and then use cognitive behavior therapy for treatment.

With the constant expansion of the online world, Greenfield says the problem of Internet addiction will likely grow.

An International Leader:
UConn’s Alcohol Research Center

UConn’s Alcohol Research Center (ARC) is an international leader in the treatment of alcoholism, in both the pharmacotherapy — the use of drugs in treatment — and behavioral therapy. ARC was established at the UConn Health Center in 1978 by the National Institute on Alcohol Abuse and Alcoholism, a part of the National Institutes of Health (NIH).

Among ARC’s significant accomplishments is the support of research showing the effectiveness of naltrexone, the first drug approved to treat alcoholism in the last 50 years, and on a second newly approved drug, acamprosate, which works by reducing the pleasurable effects of alcohol. Other clinical research projects include studying the success rate of brief behavioral treatments on alcoholism showing that just three to five sessions with a therapist can help people to significantly reduce their hazardous drinking. ARC has also developed a questionnaire to screen for alcohol use problems that is used by health care professionals worldwide.

“We want to get the tools into the hands of teachers, parents and employers who can identify individuals at risk to make inroads on the problem,” says Victor Hesselbrock, scientific director of the Alcohol Research Center and vice chair of psychiatry at the UConn School of Medicine.

Another key effort of ARC is its focus on identifying genetic susceptibility factors, including taking part in the multi-center, NIH-funded Collaborative Study on the Genetics of Alcoholism (COGA), which seeks to identify the susceptibility genes for alcoholism and other addictions.

UConn is one of six research institutions working together to detect and map susceptible genes for alcohol dependence and related phenotypes. The COGA database contains information on 1,500 families of alcohol-dependent patients from across the U.S. The data includes clinical information based on personal interviews, medical records and laboratory assessments such as blood biochemistry, genetic markers and psychological test performances.