We are the Addiction research group and are based in the Department of Psychological Sciences, University of Liverpool.

Professor Matt Field (research group leader): I'm a Professor of Psychology at the University of Liverpool. I studied at the Universities of Swansea and Sussex, and then worked as a postdoc at the University of Southampton before moving to Liverpool in 2004. My primary interests are the cognitive and motivational processes that underlie heavy drinking and other types of substance use. For example, I am interested in the roles of attentional bias, and  impulse control in the development of  problem drinking, and their influence on  alcohol consumption in the laboratory. My research has been funded by the Medical Research Council, Wellcome Trust, Economic and Social Research Council and Alcohol Research UK. Follow @field_matt on twitter

Dr Abi Rose: I have been a Lecturer in Psychology at the University of Liverpool since 2010. I obtained my PhD in Experimental Psychology from the University of Sussex in 2006, and then worked as a postdoc at St George’s Medical School, UCL, before taking an appointment as Lecturer at the Institute of Psychiatry, KCL. My research interests are focused around the psychopharmacological basis of addiction and specifically identifying pathways into and out of hazardous drinking. My laboratory-based research investigates the processes involved in drinking, including the interaction between environmental and intoxication effects, while my clinical research focuses on developing more effective psychosocial treatments and pharmacotherapies. For example, I am interested in the priming effects of alcohol, the learning mechanisms underlying drinking behaviour, and the pharmacological basis of alcohol dependence. My research has been funded by the Medical Research Council, Economic and Social Research Council, and Alcohol Research UK. Follow @abirose9 on twitter.

Dr Paul Christiansen: I have been a Lecturer in Psychology at the University of Liverpool since 2013. I obtained my PhD in Experimental Psychology from the University of Liverpool in 2012, and taught extensively while doing my PhD. My research interests are focused around self control over drinking. For example I have recently investigated the influence of self control depletion on drinking in the laboratory. I have also conducted research into the acute and anticipated  effects of alcohol on automatic and executive cognitive processes and how these processes relate to the alcohol priming effect.  I am also interested in the development of personalised stimuli for use in the assessment of attentional bias. My research has been funded by Alcohol Research UK. Follow @ChristiansenLiv on twitter. 

Dr Charlotte Hardman: I have been a Lecturer in Psychology at the University of Liverpool since 2013. I studied at the University of Leeds (BSc) and Bangor University (PhD) and then worked as a postdoc at the University of Bristol. My research examines the psychological and biological control of appetite, food intake and addictive behaviours. For example, I am interested in affective and non-affective determinants of food reward (“liking” and “wanting”) and the influence of cognitive factors, such as attention, memory and expectations, on the amount of food that people consume. I am also interested in the extent to which over-eating can be thought of as an addictive behaviour. My research has been funded by the Economic and Social Research Council and the Welsh Assembly Government. Follow @CharlotteHardm3 on twitter. 

Dr Eric Robinson: I am a tenure-track research fellow and have worked at the University of Liverpool since 2013. I am interested mainly in social context and alcohol use – why is it often the case that people around us will influence how much we drink and why does this happen? I am also keen on examining how beliefs we hold about ourselves and others can shape alcohol and drinking behaviour.

I also do work examining eating behaviour and obesity, which can be found here – http://www.liv.ac.uk/psychology-health-and-society/staff/eric-robinson/. Follow @eric_robinson_ on twitter. 

Dr Andrew Jones (Post-doc): I studied for both my undergraduate degree in psychology and my PhD at the University of Liverpool before starting my post-doc in December 2012. My primary interest is the relationship between impulsivity and alcohol-use. My work involves examining ‘state’ fluctuations in (dis)inhibition, and whether they can influence alcohol-seeking (see here and here). I am also interested in general processes that underlie motivated behaviours, such as attention. Follow @ajj_1988 on twitter.  

Elly McGrath (Research assistant): I have completed a Bachelor’s degree in Psychology from the University of Manchester. I have previously worked as a Research Assistant on an NIHR funded project investigating a CBT intervention for Bipolar Disorder and co-morbid anxiety and a project running an online intervention with the Royal Liverpool University Hospital for patients experiencing difficulties managing their emotions in relation to cancer. I am currently working on the Medical Research Council grant on state disinhibition and heavy drinking, and my interests are in cognitive processes and cultural influences concerning alcohol use and non-specific effects of addiction treatment

Natasha Clarke (First year PhD student): I studied for both my undergraduate and Master’s degree at the University of Liverpool. My interest is in methods and approaches that can be used to reduce the harm associated with excessive drinking and my current research focuses on the effectiveness of brief interventions in reducing unit consumption in young adults. My research is funded by the Economic and Social Research Council and Alcohol Research UK. Follow @tash_c135 on twitter. 

Jay Joseph Duckworth (First year PhD student): I am studying psychopharmacology at the University of Liverpool. In particular I’m attempting to find out whether work with non-human animals into sign-tracking and goal-tracking behaviours can be extrapolated to humans, using both cognitive and behavioural measures to accomplish this. I’m also interested in the wider scope of psychopathology. Follow @JayDuckworth on twitter. 

Lisa Di Lemma (First year PhD Student): I am investigating “Overcoming  disinhibition and retraining automatic tendencies in heavy drinkers and tobacco smokers”. I studied Psychology in Rome and moved to London in 2011 for my Masters in Research Methods and Psychology in London City University. In 2012-2013 I worked as a Research Assistant in the University of Liverpool, investigating the role of Motivational Ambivalence in predicting relapse in alcohol dependent patients. My research interests are currently focused on cognitive and motivational process in heavy drinkers and smokers. In particular I am interested on: Disinhibition, Implicit Motivational Tendencies and Motivational Ambivalence. Follow @DiL_Lisa on twitter. 

Inge Kersbergen (First year PhD student): I have completed a Bachelor in Psychology and Research Master in Behavioural Science at the University of Nijmegen, the Netherlands. I’m mainly interested in automatic processes that guide behaviour. My PhD is funded by the UK Centre for Tobacco and Alcohol Studies (UKCTAS) and will look into cognitive processing of advertisement and warning labels on alcohol and tobacco products and their effect on behaviour.

Paweł Jędras (Second year PhD student): I hold a Master’s degree in psychology of addictive behaviours and Bachelor’s degree in psychology from the University of Liverpool. During my Bachelor’s project I analysed the role of planned behaviour and impulsivity in predicted and actual alcohol consumption, especially emphasising potential applications of cusp catastrophe in modelling of heavy episodic drinking, whereas my Master’s thesis was about the effects of thought suppression on alcohol approach bias after priming of positive or negative alcohol-related information. Although my current research is mainly focused on the effects of reward and punishment anticipation on the attentional bias in the visual processing of motivationally salient stimuli, I am also interested in various issues related to addiction including historical and cultural aspects of drugs and drug policy.

Helen Ruddock (First year PhD student): My main areas of interest include appetite, obesity and addiction. Currently, my research focuses on the behavioural and cognitive manifestations of ‘food addiction’.  Prior to starting my PhD, I completed a BSc in Psychology at the University of Plymouth, and an MSc in Neuropsychology at the University of Bristol. During my MSc, I conducted research into the role of loss aversion on food portion-size selection. Follow @helzbelz1984 on twitter. 

New drug has potential to treat marijuana addiction

This is the original version of an article that was written by Matt Field and edited for The Conversation, you can find that version here. 

More than 1.2 million Americans per year seek treatment for problems with their marijuana (or cannabis) use. Cannabis use disorder is recognised in the same category as other substance use disorders (‘addictions’), in the Diagnostic and Statistical Manual of Mental Disorders, and up to 1% of the European population may warrant this diagnosis. Psychological treatments such as motivational interviewing and cognitive behaviour therapy may be effective, although there have been very few controlled trials of these therapies. A recent review concluded that there were no effective medications for the prevention of relapse to cannabis use.

Like other addictive drugs, Delta-9-tetrahydrocannabinol (THC; the main psychoactive ingredient in cannabis), produces its rewarding effects by stimulating dopamine release in the brain’s reward system, a network of brain structures including the Nucleus Accumbens (NAcc) and the ventral tegmental area (VTA).   Therefore, one potential way to treat addictions would be to give medications that block dopamine activity in the reward system, such as the dopamine antagonist drugs that are used to treat schizophrenia. Unfortunately, these drugs have some unpleasant side-effects. More fundamentally, dopamine antagonists block all forms of reward, not just drug-induced reward. Therefore, the search is on for drugs that can interfere with drug-induced reward without producing unpleasant side-effects, and without interfering with the response to other rewards.

            A study recently published in Nature Neuroscience has identified a promising potential new medication for cannabis use disorders. The drug, RO 61-8048, leads to increases in levels of kynurenic acid (KYNA). Through a fairly complicated mechanism, what this does is block the ability of THC (and similar compounds) to increase dopamine activity in the brain’s reward centre. Most importantly, although the drug can blunt the effect of THC on dopamine levels, it has no effect on dopamine levels when given on its own. In this paper, the authors conducted a series of studies with rodents and primates, and they found that:

• The drug prevented the increase in dopamine levels in NAcc and the VTA that normally occurred after infusion of THC.
• The drug blocked the reinforcing effects of THC: after receiving the drug, animals were less likely to press a lever in order to obtain injections of THC or a related compound.
• The drug could block the rewarding effects of THC. For example, animals will normally press a lever to receive THC if they have just been given an injection of THC or if they have been presented with environmental signals that THC was available (these tests are considered animal models of relapse to drug use). The drug reduced both of these effects.
• These effects of the drug were specific to THC, because the drug did not affect the reinforcing properties of another reward: food. Animals were prepared to press a lever in order to win food pellets, regardless of whether they had received the drug or not.
• At the doses studied, the drug had no effect on working memory, and did not change the memory-impairing effects of THC. 

These findings are potentially important because has been very difficult to develop medications that block drug-induced reward without also interfering with the response to other rewards. The safety of the drug, and its effectiveness as a treatment for cannabis use disorders, should now be studied in human volunteers.

We should be cautious, however. Even if the drug is safe in humans, and it can reduce the rewarding effects of cannabis, this will not make it a panacea for cannabis use disorders. Medications for other substance use disorders, such as naltrexone for alcohol use disorders and buprenorphine for opiate use disorders are prescribed because they reduce the rewarding effects of alcohol or heroin if those drugs are consumed. Although the drugs are effective, if a patient decides that they want to experience the rewarding effects of alcohol or heroin again, all they have to do is stop taking their medication. This is also likely to be the case for RO 61-8048 and cannabis use disorders. Medication implants and depot formulations may partly solve this problem.

Is the adolescent brain wired for addiction?

This article was written by Matt Field.It started out as an opinion piece for the University of Liverpool news pages.  It was then slightly modified as a 'Hard Evidence' piece for The Conversation, and then somehow it ended up on the New Statesman site.

As a nation, we are drinking much more than we used to, which is partly attributable to alcohol being cheaper and more available than ever. Many British teenagers get into the habit early, although recent trends suggest this situation is improving (alcohol consumption among teenagers is slightly lower than it was ten years ago).

Nonetheless, drinking alcohol during adolescence is not a good idea, because the younger you are when you have your first alcoholic drink, the more likely you are to develop problems later on in life. The same is true for cigarette smoking and the use of illicit drugs such as cannabis and cocaine.

Rates of teenage drinking are dropping. NatCen

Click to enlarge

Arrested development

Why are adolescents particularly vulnerable to addiction? A large part of the answer comes from our understanding of the neurobiology of brain development during adolescence. The brain does not reach maturity until fairly late in life, with new connections between brain cells being formed right up until people are in their mid-20s.

Importantly, the brain does not mature at a uniform rate. The more primitive regions of the brain, including the reward system and other areas of the subcortex such as those parts that process emotions, reach maturity relatively early (when people are in their early teens).

The prefrontal cortex is a late bloomer. National Institute of Health

The more “advanced” parts of the brain, such as the prefrontal cortex, are not fully developed until much later. In behavioural terms this means adolescents are particularly sensitive to their emotions and to things that are novel and motivationally appealing, but they are relatively unable to control their behaviour and plan for the future.

Taking risks

My research suggests this can explain why some adolescents drink more than others: teenagers who were relatively poor at exerting self-control, or who took more risks on a computer test of risk-taking, were more likely to drink heavily in the future.

This creates perfect conditions for vulnerability to addiction during adolescence, because the motivational “pull” of alcohol and other drugs is very strong, whereas the ability to control behaviour is relatively weak. Many scientists think if adolescents do drink a lot, and if they do it frequently, then this might cause long-lasting changes in the way that the brain is organised, which can make it very difficult to stop drinking.

We certainly see changes in the brains of people with alcohol problems (compared to people without problems), but it can be difficult to work out if alcohol caused those brain changes, or if those people had slightly different brains before they started drinking, and these subtle differences may have led them to start drinking in the first place.

Starting early carries greater risk. NatCen

Addiction and behaviour

In principle, adolescent brains could be vulnerable to “behavioural” addictions as well as alcohol and drug addiction, for exactly the same reason. Very few behavioural addictions are officially recognised by psychiatrists and psychologists at the moment (gambling addiction is the only exception).

The Channel 4 documentary Porn on the Brain shown this week asked whether pornography is addictive, and if adolescents could be getting hooked. As shown in the programme, it certainly seems to be the case that a minority of adolescents who use pornography exhibit some of the characteristic features of addiction, such as feeling unable to control their use of porn, and loss of interest in other activities.

Their patterns of brain activity when viewing porn seem to be similar to those seen in people with alcohol and drug addictions when they look at pictures of alcohol and other drugs. It remains to be seen whether addiction to porn will eventually be recognised as a psychological disorder, but it is clear that it can create problems for some adolescents and young adults who use it.

What can be done? Although it’s obvious, parents should do what they can to prevent their children from experimenting with alcohol, smoking and other drugs for as long as possible. The same applies to other things that might eventually be considered “addictive”. School-based prevention programmes can also be successful, including a recent program that is tailored to different personality types and has shown some promise at reducing alcohol consumption in teenagers.

Primary care interventions for alcohol misuse: US Preventative Services Task Force recommendations

This post was written by Paul Christiansen for the Mental Elf blog, you can find the original here

Alcohol misuse is recognised as one of the major health care issues in the US. Specifically, alcohol misuse is ranked third in causes of preventable deaths (after tobacco and obesity) affecting 30% of the population. Alcohol dependence has 4% prevalence in the US, but hazardous drinking patterns are believed to be evident in 21% of adults, contributing to a range of health concerns including gastritis, liver disease, pancreatitis and anxiety. In addition, 23% of 17 year olds reported at least one episode of heavy drinking in the previous fortnight. Significantly, heavy drinking is the major contributing factor to traffic accidents, the leading cause of death in US teenagers (Miniño, 2010).

Heavy drinking contributes to traffic accidents, which are the leading cause of death in US teenagers

The US Preventative Services Task Force (USPSTF) is an independent group of experts who make evidence-based recommendations about preventative services and interventions with the goal of improving the health of Americans. The current paper largely focuses on hazardous alcohol use which they define as drinking more than three (females) or four drinks (males) in a single session.

Their latest recommendations published here are specifically concerned with the efficacy of brief behavioural counselling interventions in primary care settings, and assessing which screening tests for alcohol misuse are most sensitive. Clear recommendations for adults are made although the authors conclude there is not sufficient evidence to recommend any primary care interventions for adolescents.

Methods

The USPSTF have based their recommendations on a review of treatment trials published between 1985 and 2011, and reviews and meta-analyses published between 2006 and 2011, which investigated behavioural counselling and screening procedures in adults, pregnant women and adolescents. Although this is largely a review article, there are also some statistics reported based upon meta-analysis of selected studies. The USPSTF specifically examined:

• Direct evidence for the effectiveness and accuracy of screening instruments
• The effectiveness of various brief behavioural counselling interventions for improving intermediate and long-term outcomes (23 trials)
• Possible harms of these procedures

Among the screening instruments were many that readers will be familiar with, for example the Alcohol Use Disorders Identification Test (AUDIT), the AUDIT-Consumption (AUDIT-C; essentially the first three questions from the standard AUDIT). Other screening instruments investigated include single question methods e.g. “how many times in the previous year have you consumed over 5 drinks in one day?”, the Rapid Alcohol Problems Screen and Alcohol-Related Problems Survey.

Brief behavioural counselling strategies reviewed included face to face, telephone contact, online resources and self help manuals that include a range of cognitive-behavioural strategies such as action plans, stress management and problem solving. Counselling durations ranged from brief single contact (less than five minutes) up to extended multi contact (more than one session of over 15 minutes). Unfortunately the impact of different forms and durations of counselling were not specifically analysed, although an earlier systematic review (Jonas et al, 2012) in the same journal reported that the efficacy of counselling interventions improves with increased contact time.

Results

This is what they found:

Brief behavioural counselling can reduce multiple indices of alcohol misuse, although the long term advantages are not clear

• The AUDIT was the most sensitive screening tool with a 4+ cut off having the greatest sensitivity to alcohol misuse
• AUDIT-C and single question screens were also found to be sensitive screening instruments
• Meta-analysis of relevant studies revealed brief behavioural counselling significantly reduces binge drinking, total number of drinks per week, risky drinking patterns and incidents of exceeding recommended limits. Furthermore, there were no reported harms of the interventions
• Significantly, meta-analysis of the nine trials that assessed long term outcomes found no evidence of significant improvement following brief behavioural counselling
• Although found to be effective in both young and older adults, there was limited evidence for the efficacy of brief behavioural counselling in pregnant women and no evidence (due to a lack of research) on the efficacy of brief behavioural counselling in adolescents

 Conclusions

• The AUDIT is the most sensitive screening measure of alcohol misuse
• Overall, brief behavioural counselling can reduce multiple indices of alcohol misuse, although the long term advantages are not clear
• There is a severe lack of research investigating the impact of these interventions on adolescents

The authors concluded with these key recommendations:

The USPSTF recommends that clinicians screen adults aged 18 years or older for alcohol misuse and provide persons engaged in risky or hazardous drinking with brief behavioural counselling interventions to reduce alcohol

BUT

…the current evidence is insufficient to assess the balance of benefits and harms of screening and behavioural counselling interventions in primary care settings to reduce alcohol misuse in adolescents

This guidance highlights a lack of research investigating the impact of these interventions on young people

To summarise, this review indicates that any brief behavioural counselling interventions in primary care settings can improve short term alcohol outcomes in adults. Although it is notable that no recommendations were made in relation to adolescents due to the paucity of research.

Overall, this review offers some clarity to practitioners regarding the efficacy of brief behavioural counselling, although it does not make clear which forms of intervention (manual, telephone face-to-face) are most effective. The recommendation of the AUDIT as a screening tool adds to the large evidence base demonstrating this to be a reliable and sensitive instrument. Finally, the lack of recommendations for adolescents highlights the need for investigations into brief behavioural counselling in this population, if they are relatively cheap and effective in adults this indicates that they could be a useful clinical tool in adolescents.

The Elf would like to add a note of caution to experimental psychologists; the use of the 4+ cut off to define risky drinkers in a sample of UK undergraduates would probably lead to great difficulty in finding non-risk participants 

Links

Virginia A. Moyer, on behalf of the U.S. Preventive Services Task Force; Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine. 2013 Aug;159(3):210-218.

Jonas DE et al Behavioral Counseling After Screening for Alcohol Misuse in Primary Care: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force. Annals of Internal Medicine. 2012 Nov;157(9):645-654.

Miniño AM. Mortality Among Teenagers Aged 12–19 Years: United States, 1999–2006 (PDF). National Center for Health Statistics Data Brief, No. 37, May 2010.

  Follow @ChristiansenLiv on twitter.