Associate Professor of Psychiatry at UCLA who studies and treats addictive behaviors, Principal Investigator at UCLA Integrated Substance Abuse Programs.
Dr. Glasner-Edwards has been licensed with the California Board of Psychology since 2004. She has a B.A. in Psychology from the University of California at Los Angeles and a Ph.D. in Psychology from the University of Minnesota. She has a holistic, integrative approach to help treat substance use disorders, using a variety of interventions, including motivational, cognitive behavioral, and mindfulness-based strategies. She teaches these techniques at UCLA. Dr. Glasner-Edwards is currently working on research that evaluates addiction treatment outcomes and also on developing technology-based interventions for addiction and related health conditions.
Currently, Dr. Glasner just completed a relapse prevention therapy pilot study designed for people addicted to opioids. It’s a text messaging intervention.
Background. In the past, she has conducted clinical trials and supervised research therapists who provide behavioral treatment in clinical trials. In one clinical trial, adults who were addicted to opioids either got medication or medication plus therapy. After a period of time she was hearing feedback that patients often preferred to just take their medications, because not all of the topics covered in therapy were relatable to their own lives. However, without therapy, she found that patients were not well equipped to deal with stressful situations (or other relapse triggers), leaving them more prone to relapse. She observed, consistent with research on behaviors that optimize outcomes from addiction treatment, that individuals engaged in psychotherapy or self-help groups on an ongoing, longer-term basis had better outcomes from treatment. If therapy for addiction could be tailored to the individual, and delivered in a way that would demand less time in a medical office, she thought that they might be more compliant and engaged in it.
Pilot study. Participants enrolled in the study received individualized therapy in a tailored way through text messaging over 12-weeks. It was interactive. Participants would receive information about their treatment or recovery in general and then every third or fourth text was interactive. For example, an interactive text might say, Are you feeling triggered today? If they responded with, no, they would receive another encouraging message saying something like, Great, you’re doing so well in your recovery. If they responded with, yes, based on information gathered in the first meeting to individualize therapy and help the person to keep motivated to stay on track, a personalized reminder would be sent to the patient, such as, think of your daughter Tammy.
She also worked with drug users infected with HIV to help them adhere to medication. For someone hooked on opioids, medication is often part of their treatment.
Results. Initial analysis of results showed that participants reduced their use of drugs, risky behaviors, and depression, and increased plenty of healthy indicators. The study also helped people to take their medication consistently (which was verified by biological measures). She’s in the process of publishing her findings. Overall, participants’ feedback was really positive.
Treatment. Withdrawal is really tough, leading some addicts to require medication to recover. Medication for individuals addicted to opioids, formally known as “opioid substitution therapy,” can help them to restore their ability to function normally. The brain’s chemistry of opioids changes with repeated use of the drug, with the addiction gradually taking over behavior so that the main goal pursuit becomes acquiring and using opiates. Medication replacement therapy brings the level of opioids to a steady state. Without the medication users struggle with highs and lows, leaving some to experience bad behavior, criminal activities, doctor shopping, etc.
If people just go through detoxification, 90% or more typically relapse. There needs to be maintenance medication plus therapy. Research studies on relapse show the longer people remain in the state of treatment the better. Addiction is a chronic illness. There needs to be an ongoing element of support in their life. Sobriety is an issue they need to take care of and have reminders they could relapse at any time. Putting support in place helps to prevent it. Even having people you can call to cope with during the toughness of life. Sobriety needs to be worked on continually.
One of the common denominators of relapse is impulse control. Certain regions of the brain are linked with impulsivity. All addicts are triggered by certain things. The addicted part of their brain drives them to use again and justifies using. It’s caused, in part, by poor impulse control, poor decision-making, not having enough confidence in themselves, and many other complex reasons.
IDEAS FOR THE CHALLENGE: Early detection. It could be looking for a marker of stress reactivity because a persons stress response often mirrors withdrawal symptoms such as, nausea and increased heart rate. Stress reactivity markers could be cortisol, blood pressure, pulse, etc. There is just so much variability in terms of what makes people relapse, that the solution should ideally be individualized. It is difficult to pinpoint a universal biological or neurological chemical marker.
• Keep people engaged in some form of treatment or support structure that assists with the ongoing process of recovery for the long-term. Studies show the longer you’re in therapy the better. Addiction is a chronic disease; like diabetes, it needs to be managed.
• You can utilize a technology that capitalizes on social media, tracks missed doctor’s appointments, therapy group attendance, and other indicators that the individual is attending to their health and well-being.