A developmental model of addictions: integrating neurobiological and psychodynamic theories through the lens of attachment

ABSTRACT

Although substance use and abuse may impact brain and behavior, it is still unclear why some people become addicted while others do not. Neuroscientific theories explain addiction as a series of between- and within-system neuroadaptations that lead to an increasingly dysregulating cycle, affecting reward, motivation, and executive control systems. In contrast, psychoanalysis understands addiction through a relational perspective wherein there is an underlying failure in affect regulation, a capacity shaped early developmentally. Considering recent findings suggesting the neurobiological overlap of addiction and attachment, it may be possible to integrate both perspectives into a developmental model through the lens of attachment. The goal of the present review is to evaluate the value of neurobiological and psychodynamic perspectives to inform our understanding of addiction, particularly substance-use disorders.     

A New Look at Peripheral Vascular Disease in Blacks: A Two-Year Update

A comprehensive overview of 66 patients—the majority of whom were black—undergoing distal lower extremity revascularization for severe atherosclerotic ischemia with impending limb loss is presented. Twenty-five patients are presently two-years postoperative, 19 are one-year post revascularization, and 22 are new additions having undergone revascularization within the last year.     

A Histologist's Look at the Pancreas: Part I

Abstract

We report the development of the first automated method for immunocytochemistry using the Code-On Immunology System, an IBM System II driven triaxial robotic slide staining unit. The system uses a unique capillary action design to apply, incubate, and sequentially remove reagents from planar glass microscope slide surfaces. The instrument is capable of analyzing 60 slides for 30 different antigens in 2 hours and 35 minutes or less. The system performs complete immunoassays from dewaxing to nuclear staining and saves over 80% of organic reagents and up to 50% of immunochemicals. The importance of automation to the future of immunocytochemistry and molecular pathology is discussed.     

Transfer of EMG Training: Another Look at the General Relaxation Issue

A study was made of the extent to which electromyographic (EMG) response-decrease training with biofeedback on each of two successive sites would affect the other site in terms of generalization and transfer of training. Thirty-two subjects were assigned to four groups of equal size. Groups Frontal-Arm and Arm-Frontal were first provided with auditory feedback for EMG responses on either the forehead (frontal) or forearm extensor areas in an initial set of training sessions and on the alternate area in a second set of training sessions. Control groups Relax-Arm and Relax-Frontal were provided with instructions designed to induce “motivated relaxation” on one of the two sites in initial training followed by biofeedback training on the alternate site in subsequent training. The EMG training, but not the instructions, resulted in reduced EMG potentials in both the forearm and frontal areas. However, training on one site did not appear to facilitate more rapid acquisition of reduced potentials (transfer of training) during subsequent biofeedback on the alternate site. There was also no evidence for generalized training effects in the form of reduced potentials on other sites, skin temperatures, or self-reports at the time of training on one site.     

P300 and Response Selection: A New Look Using Independent-Components Analysis

Purpose: The most prevalent current view of the functional role of the P300 component of the event-related potential (ERP) is that it indexes strategic processing related to context updating. Using independent-components analysis (ICA), the present study examined the role of P300 in the tactical process of response selection. Methods: In a task crossing manipulations of perceptual difficulty (PD) and response-selection difficulty (R-SD), ICA was employed to measure not only P300 latency, but its onset and duration as well. Results: Increased PD delayed P300 latency and onset in parallel, while increased R-SD lengthened P300 duration. Conclusions: The latency and onset results suggest that the often-cited covaration of P300 latency with stimulus-evaluation time is secondary to effects on processing stages preceding P300. The results for duration indicate that P300 is involved in response selection, suggesting that it is not a unitary phenomenon. While P300's well-known relation to stimulus probability indicates a strategic role, our findings indicate a tactical role as well.     

Developmental Needs Meeting Strategy: A New Treatment Approach Applied to Dissociative Identity Disorder

ABSTRACT

This article describes the use of the Developmental Needs Meeting Strategy (DNMS) for the treatment of dissociative identity disorder (DID). The DNMS is an ego state therapy which guides a client's own internal resources to meet developmental needs that were not met in childhood. After 17 months of DNMS treatment, a client with DID reported a near total elimination in frequency and severity of symptoms of depression, anxiety and suicidal thoughts, her Trauma Symptom Inventory scores indicated no trauma-related symptoms, and her Multidimensional Inventory of Dissociation scores indicated she no longer met the diagnostic criteria for DID. She was functioning well without any medication. Further research concerning this treatment strategy is warranted.     

Wishing Doesn't Make It So: A Close Look at Stehbens' "Refutation"

In 1982 we failed to replicate findings of Stehbens and associatesconcerning a disproportionately high percentage of newly diagnosedchildren with cancer exhibiting Verbal-Performance discrepancyof 15 points or greater. In addition we raised several methodologicalquestions about Stehbens' study. In a current article Stehbensclaims to refute our critique. However a close examination ofthe "refutation" reveals it to confirm our initial conclusions.     

Subtypes of developmental dyslexia in transparent orthographies: A comment on Lachmann and Van Leeuwen (2008)

Lachmann and Van Leeuwen (2008) proposed two diagnostic subtypes of developmental dyslexia in a language with transparent orthography (German). The classification was based on reading time, rather than reading errors, for lists of words and nonwords. The two subtypes were “frequent-word reading impaired” (FWRI) and “nonword reading impaired” (NWRI). Notably, FWRI were very slow in reading high-frequency words but as fast as controls in reading nonwords; ca. one-third of these children showed this “reversed lexicality effect” in a particularly marked fashion (i.e., read nonwords two to three times faster than high-frequency words). Since Italian is a highly transparent language, we applied this classification to 87 third- and sixth-grade dyslexics from various previously published studies. Some children showed a marked lexicality effect, while others showed small or no difference between word and nonword reading speed. However, regardless of stimulus length, grade and presence/absence of a previous language delay, no child showed a marked reversed lexicality effect; more generally, no child could be classified as FWRI. These findings indicate that the search for subtypes of developmental dyslexia in transparent orthographies still constitutes an open question.     

Zinc deficiency and behavior: A developmental perspective

Zinc deficiency was induced in 35 and 300 day-old male Holtzman rats. Group ZDA was fed ad lib a diet deficient in zinc (1 ppm), ZSP controls were pair-fed a diet supplemented with zinc (50 ppm) and ZSA controls were fed ad lib a diet supplemented with zinc (50 ppm). Physical status and six open-field behaviors were evaluated. Food intake, body weight and plasma zinc concentrations were significantly reduced in both age groups. Expanded use of the open-field revealed significantly lower latencies to explore the novel environment and significantly lower ambulation scores in the young and older zinc deficient rats. Older rats spent significantly less time grooming than their controls. Rearing was significantly less in young zinc deficient rats and “kangaroo-like” posture was evident. Young rats made deficient during critical periods of growth and development, were at greater risk for most parameters tested, compared to the older deficient rats. These results do demonstrate, however, that feeding low-zinc diets to older, fully developed animals results in significant physical and behavioral impairment.     

Effect of Breastfeeding Duration on Cognitive Development in Infants: 3-Year Follow-up Study

We investigated the association between breastfeeding and cognitive development in infants during their first 3 years. The present study was a part of the Mothers’ and Children’s Environmental Health (MOCEH) study, which was a multi-center birth cohort project in Korea that began in 2006. A total of 697 infants were tested at age 12, 24, and 36 months using the Korean version of the Bayley Scales of Infant Development II (K-BSID-II). The use and duration of breastfeeding and formula feeding were measured. The relationship between breastfeeding and the mental development index (MDI) score was analyzed by multiple linear regression analysis. The results indicated a positive correlation between breastfeeding duration and MDI score. After adjusting for covariates, infants who were breastfed for ≥ 9 months had significantly better cognitive development than those who had not been breastfed. These results suggest that the longer duration of breastfeeding improves cognitive development in infants.     

Osteological Associations With Unique Tooth Development in Manatees (Trichechidae,Sirenia): A Detailed Look at Modern Trichechus and a Review of the Fossil Record

Modern manatees have a unique type of tooth development, continually forming identical new molars in the posterior end of each quadrant of their mouths, and then progressively moving teeth anteriorly, only to reabsorb roots and spit out worn crowns. This process is not only developmentally complex, but requires space in the oral cavity that imposes its own limitations on other uses of that space. To gain a clearer understanding of the anatomical constraints on the evolution of this unique developmental process, we identified the specialized craniodental features in modern Trichechus that permit this specialization using visual observation and CT. Furthermore, to better understand the evolution of these traits, we review the fossil record of trichechids for these traits, including CT analysis of the skull of Miosiren kocki, a possible early member of the family from the Early Miocene of Belgium. Anat Rec, 2012. © 2012 Wiley Periodicals, Inc.     

The Human Shoulder Suspension Apparatus: A Causal Explanation for Bilateral Asymmetry and a Fresh Look at the Evolution of Human Bipedality

The combination of large mastoid processes and clavicles is unique to humans, but the biomechanical and evolutionary significance of their special configuration is poorly understood. As part of the newly conceptualized shoulder suspension apparatus, the mastoid processes and clavicles are shaped by forces exerted by the musculo‐fascial components of the cleidomastoid and clavotrapezius muscles as they suspend the shoulders from the head. Because both skeletal elements develop during infancy in tandem with the attainment of an upright posture, increased manual dexterity, and the capacity for walking, we hypothesized that the same forces would have shaped them as the shoulder suspension apparatus evolved in ancestral humans in tandem with an upright posture, increased manual dexterity, and bipedality with swinging arms. Because the shoulder suspension apparatus is subjected to asymmetrical forces from handedness, we predicted that its skeletal features would grow asymmetrically. We used this prediction to test our hypothesis in a natural experiment to correlate the size of the skeletal features with the forces exerted on them. We (1) measured biomechanically relevant bony features within the shoulder suspension apparatus in 101 male human specimens (62 of known handedness); and (2) modeled and analyzed the forces within the shoulder suspension apparatus from X‐ray CT data. We identified eight right‐handed characters and demonstrated the causal relationship between these right‐handed characters and the magnitude and direction of forces acting on them. Our data suggest that the presence of the shoulder suspension apparatus in humans was a necessary precondition for human bipedality. Anat Rec, 298:1572–1588, 2015. © 2015 Wiley Periodicals, Inc.     

Steep Decrease of Gender Difference in DSM-IV Alcohol Use Disorder: A Comparison of Two Nation-wide Surveys Conducted 10 Years Apart in Korea

While decreasing trend in gender differences in alcohol use disorders was reported in Western countries, the change in Asian countries is unknown. This study aims to explore the shifts in gender difference in alcohol abuse (AA) and dependence (AD) in Korea. We compared the data from two nation-wide community surveys to evaluate gender differences in lifetime AA and AD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Face-to-face interviews using the Composite International Diagnostic Interview (CIDI) were applied to all subjects in 2001 (n=6,220) and 2011 (n=6,022). Male-to-female ratio of odds was decreased from 6.41 (95% CI, 4.81-8.54) to 4.37 (95% CI, 3.35-5.71) for AA and from 3.75 (95% CI, 2.96-4.75) to 2.40 (95% CI, 1.80-3.19) for AD. Among those aged 18-29, gender gap even became statistically insignificant for AA (OR, 1.59; 95% CI, 0.97-2.63) and AD (OR, 1.18; 95% CI, 0.80-2.41) in 2011. Men generally showed decreased odds for AD (0.55; 95% CI, 0.45-0.67) and women aged 30-39 showed increased odds for AA (2.13; 95% CI 1.18-3.84) in 2011 compared to 2001. Decreased AD in men and increased AA in women seem to contribute to the decrease of gender gap. Increased risk for AA in young women suggests needs for interventions.     

Experimental Spinal Stenosis in Cats: New Insight in Mechanisms of Hydrocephalus Development

In our new experimental model of cervical stenosis without inflammation we have tested hypothesis that cranio‐spinal communication impairment could lead to hydrocephalus development. Spinal and cranial cerebrospinal fluid (CSF) space separation was obtained with positioning of plastic semiring in epidural space at C2 level in cats. Brain ventricles planimetry, and CSF pressure recording in lateral ventricle (LV) and lumbar subarachnoid space (LSS) were performed in acute and subchronic experiments. In all experiments opening CSF pressures were normal. However, in acute experiments, an infusion of artificial CSF into the LV led to increase of CSF pressure and significant gradient pressure development between LV and LSS due to limited pressure transmission. After 3 or 6 weeks spinal cord atrophy was observed at the site of cervical stenosis, and pressure transmission from LV to LSS was improved as a consequence of spinal tissue atrophy. Planimetry of both the coronal brain slices and the ventricles’ surface showed that control ventricular surface was 0.6 ± 0.1% (n = 5), and 1.6 ± 0.2% (n = 4) in animals with subchronic cervical stenosis (P < 0.002). These results support the mentioned hypothesis claiming that CSF volume cranio‐spinal displacement impairment could start pathophysiological processes leading to development of hydrocephalus.