Like most substance abusers, stimulant addicts (cocaine and methamphetamine) tend to value instant reward or gratification differently than those who are not addicted. Reduced value of a future reward is called "delay discounting" and it is being studied by experts as a key to unraveling certain aspects of addictive behavior. Neuroscientists have proposed that change in the bias towards risk taking by addicts could lead to lower levels of impulsivity. It is characteristic of addicts to take risk and value a smaller immediate reward over a later, more substantial one. A recent essay published in the Biological Psychiatry journal revealed some of the thinking and research that is associated with this area of study. [1] 

The study involved 27 patients who were being treated for stimulant abuse. Exercises were designed to enhance memory of past events that would effect the discounting of events in their future. Each patient underwent a special training program designed to promote working memory. Before and after measurements were taken of disinhibition, executive function, and delay discounting. A variety of active processes were employed to increase the participants' valuation of future risk and reward. An experimental group and a control group were formed to undertake this analysis. Simple tasks, such as memorizing phone numbers and short word lists, were completed.  At the end of the training program, delay discounting rates had been decreased by 50%. It appears that by improving memory, these patients could learn to appreciate the value of a future reward. It is in this change of thinking amongst a group of stimulant addicts that some of the neurocognitive defects of addiction are reversible.

Methamphetamine and cocaine are two powerful drugs of abuse, substances that cause profoundly debilitating effects that are difficult to reverse. The processes involved here include pathways in the limbic system where impulsivity emerges, as well as the frontal executive system that drives planning and deferred reinforcement. Whereas training addicts for multiple executive functions has not worked well, training the singular function of working memory may help addicts in comparing current and future rewards to develop a more adaptive decision making style in their lives. If future discounting is decreased, levels of impulsivity will be reduced. It is in reduced impulsivity that much of an addict's success in sobriety is sustained.

Varenicline is a widely utilized nicotine receptor agonist that is prescribed for treating the withdrawal and cravings of smoking addictions. The drug has also been associated with a variety of psychiatric disorders. A recently published report evaluated the drug's role in neuropsychiatric events. The drug company that manufactures varenicline in part funded this research. The study documented a number of untoward effects associated with the drug's use, but more importantly, cast doubt on the drug's efficacy in reducing the rates of smoking in nicotine-addicted patients[1].

Insomnia, abnormal dreams, and anger/hostility were more common in varenicline recipients than they were in placebo, but the differences were not great. At the end of the study, varenicline-using patients resorted to smoking (78% to 80%) nearly as often as non-using patients. The drug's effectiveness over placebo was unremarkable. And although the study did not replicate the frequency of adverse effects that many prior reports had, the drug's inability in reducing the incidence of return to smoking casts some serious doubts on the clinical value of the drug.

Imagine for a moment that you are out on a long walk in a forested park. The weather has yet to turn warm and sunny; the air is foggy and damp. The ground beneath you is a collection of loamy soil, fallen leaves, and pine needles. The underbrush is noticeably thick. As you traipse through the park, you happen upon a patch of ground where you find a bald head. The bald head is the subject of this month's essay. Bald head is a Greek translation of the English name for this drug. The drug is a member of an eclectic category of drugs that is headlined by such notables as LSD and ecstasy. This drug drew the attention of Dr. Timothy Leary and several of his associates. It was a 1957 essay in Life Magazine that launched the career of this drug. It quickly drew the attention of mind expansionists and went on to become a widely abused substance. This drug remains a popularly abused drug; social media posts make it clear that this substance has a strong lobby of support young adults. A klatch of middle-aged men and women are loyal devotees to this drug as well.

This drug has been banned in most industrialized societies, although in recent years it has been looked to as a means for relieving chronic, intractable pain for people suffering from cancer and cluster-type headaches. This drug is not a narcotic however. The drug is not particularly toxic. There are no known overdose deaths associated with its use. The bald head contains indoles and tryptamines, chemicals that are responsible for the cascading effects that users experience while high. The active ingredients of

this plant are absorbed into the central nervous system where they interact with serotonin receptors and pyramidal neurons in the cerebral cortex. The effects of these interactions result in panoramic effects on a user's sense of time and space. Additionally, users may find the drug to be a social lubricant, a means of facilitating personal interaction. In some scenes, this drug is a commonly encountered club drug, especially on the west coast of the United States. A very active black market for this drug exists on the Internet. Purveyors of this drug talk of varying potencies for wild strains of the bald head. Spores for highly concentrated bald head can command hundreds of dollars on the black market.

This drug is typically ingested by mouth, although in some circles smoking of dried plant material is preferred. The active ingredients are absorbed in the gut; within 30 to 45 minutes the effects of the drug are experienced. Individual differences in users can result in wildly unequal effects. In any given group of bald head users, some will be greatly intoxicated while others will remark that only the faintest of symptoms were experienced. Most users will experience a sharpening of tactile sensations. Colors and sounds will be enhanced, emboldened; they will sometimes experience extended euphoric effects from loud noise. In the club drug scene, bald head users will collect around stereo speakers and musical equipment. The pounding of the bass and the sharp notes of treble all cause a user to experience spikes in euphoria. On average, these effects last up to three hours. Tolerance to this drug develops rapidly. Users find that after 3-4 days of consistent use, the potency of a high will quickly degrade. Enthusiasts of this drug learn to space their consumption so that they maintain a 4- or 5-day interval between episodes.

For DAR trained personnel, the evaluation of a bald head user will result in the detection of classic hallucinogenic symptoms. Dilated pupils, elevated heart rate, increased blood pressure, fast internal clock, and gooseflesh (piloerection) will be prominent in someone under the influence. This drug is propounded to be an entheogen, a plant that is capable of bringing about a spiritual state of mind. In fact, this month's drug has been widely included in a variety of mystical and spiritual adventures amongst the rich, the famous, and the infamous.

By now readers must have concluded that bald head is a code name for a mushroom. In fact, this month's drug is known on the streets as "shrooms." Dried shroom material is pulverized and taken orally. Sometimes it is made into a tea; there have even been reports that a shroom paste or tar has been created. Spores for these shrooms can be quite expensive; shroom bloodlines are important towards growth of a potent strain of hallucinogen. The active ingredient in this hallucinogenic mushroom is 4-hydroxyl-dimethyltryptamine, aka: psilocin. The parent compound of psilocin is psilocybin. Called "magic mushrooms" or "shrooms" on the streets, these bald heads are more appropriately named psilocybin mushrooms.

This month's drug: Psilocybin mushrooms

For readers who deal with the addicted and the challenges of recovery, major depression is a frightening phenomenon that can oftentimes break the fragile hold that a patient has with sobriety. A recent neuroscientific study focused on the roll that folate (B vitamin) plays in regulating vital central nervous system transmitters and their movement from one nerve cell to another. In particular, scientists spotlighted the modulating action of l-methyl-folate, the principle metabolite of B vitamin folic acid as it relates to the movements of serotonin and norepinephrine. These two vital monoamine neurotransmitters are central to mood and personality; when levels of these transmitters are disrupted, for even short periods of time, mood disturbances and depression can quickly set in. Most modern SSRI anti-depressant prescription drugs (selective serotonin reuptake inhibitors) exert actions that boost low neuronal levels of serotonin and norepinephrine by slowing the forces of "under tow" that cause the transmitters to return to the synapses that released them. SSRIs help maintain a higher synaptic "sea level" for both these critical chemical messengers. It is these two transmitter systems that are particularly damaged by drug abuse and addiction. Recovery from defects in neurotransmitter levels and actions can hinder recovery and exacerbate drug cravings.

In recovery, antidepressants are frequently utilized to assist patients through periods of significant depression. But many of these patients do not respond well to medication. Some patients may be treated two to three different medications before an effective clinical response is seen. But the research into the roll of folate may herald a breakthrough in increasing the effectiveness of current antidepressant pharmacotherapy. The study mentioned above documented that folate taken orally significantly increased the odds that any given antidepressant will work. With up to 70 percent of patients requiring more than one antidepressant before benefits are experienced, the fact that a vitamin substantially increases efficacy is a very big deal.

L-methyl-folate is classified as a "medical food" and is sold and marketed under the trade name of Delpin. The research indicates that it may take up to 30 days for levels of the folate to affect a positive response. It appears that doses smaller than 15 mg do not work. There are no known side effects to l-methyl-folate. For patients in recovery who may not be experiencing the benefits sought from an SSRI, it seems reasonable that l-methyl-folate be considered for inclusion in a total therapeutic plan.

For our public safety and criminal justice readers, it is obvious that intoxication and violence rise in a direct and linear way. But until now, the research was scant. That is no longer true. A recent study published by research scientists at the University of Kentucky establishes that there is an alcohol dose-aggression relationship and that a variety of underlying factors may fuel these behaviors[1].

Anacharsis, the 6^th Century Scythian philosopher, is well known for pithy commentary. His view of man as his own chief enemy fits in with his commentary on alcohol. Anacharsis remarked, "The first draught serveth for health, the second for pleasure, the third for shame, and the fourth for madness." This description of a linear progressive route to alcohol-caused incapacitation has never been quantified until now. The study applied several respected investigational measurements for aggressive tendencies to a variety of different alcohol intoxicated subjects. This study was unique because it included a control and a placebo group. The results indicated a significant linear increase in aggression as alcohol levels increased in the body. The behaviors noted applied to men and women, a surprise to some drug and alcohol experts. The mathematics employed here makes it clear that the more you drink the nastier you become. This adds credence to the police maxim that a .15 BAC level of intoxication (or higher) is "fighting drunk." Behaviors at lower doses, those typically found well under the legal presumptive level for drunken driving (.02 to 0.4 BAC) did not correlate to aggressive behavior. Both provoked and non-provoked aggressive behaviors were definitely correlated to rising blood alcohol levels at the legal limit for driving and above. The study did not assess the effects of critically high blood alcohol levels on aggression, the types of alcohol consumption frequently encountered by police and other public safety officers. With prior studies tending to indicate that lower doses of alcohol actually decreased tendencies towards violence, this report casts doubt on the reliability of those findings. Regardless of the amount of alcohol consumed, the more the alcohol, the more likely that Anacharsis' lament applies.