Minister Brady Announces Publication Of 2008 Annual Report Of The Alcohol Marketing Communications Monitoring Body, Ireland

Ms Aine Brady T.D. Minister for Older People and Health Promotion, announced the publication of the 2008 Annual Report from the Alcohol Marketing Communications Monitoring Body (AMCMB). The AMCMB was established to monitor the level of adherence by advertisers and media owners to the Codes of Practice on Alcohol Marketing, Communications and Sponsorship. The AMCMB has concluded that there continues to be overall compliance with the Codes.


The Codes of Practice, which have been agreed between the Department of Health and Children and the Irish alcohol industry and the Irish advertising industry, are in place to limit the exposure of children and young people to alcohol advertising in Ireland. These Codes are intended to be complementary to existing statutory obligations and other voluntary codes that exist such as the codes of the Broadcasting Commission of Ireland and the Advertising Standards Authority for Ireland.



"The Codes on Advertising and Sponsorship, which are in place in Ireland, are among the strongest voluntary Codes in place in the European Union. However, there is no reason to be complacent and we will continue to monitor adherence to the Codes and to identify what further measures that might be necessary to reduce exposure of children and young people to alcohol advertising." The Minister said


Read the Report

Source
Department of Health and Children, Ireland

Denial In Drug Addiction May Be Explained By 'Insight' Deficit

Drug abusers are often characterized as being in "denial" - not recognizing the severity of their disorder. Although "denial" is often considered to be a form of deception, emerging research suggests that it may be due to a specific brain dysfunction similar to that observed in other neuropsychiatric illnesses.



Scientists from a variety of fields presented relevant research during a symposium on "Impaired Insight into Illness in Drug Addiction" at the Society for Neuroscience annual meeting in Washington, D.C., November 16, 2008, 8 a.m. - 11 a.m., Washington Convention Center, Ballroom B. Rita Z. Goldstein, a psychologist who leads the neuropsychoimaging group at the U.S. Department of Energy's (DOE) Brookhaven National Laboratory, is chair of this symposium; Steve Grant of the National Institute on Drug Abuse (NIDA) will co-chair it.



"The more we understand about the brain mechanisms affected by drugs of abuse and that underlie addiction, the better equipped we will be to address its complex and difficult-to-treat symptoms, including relapse triggered by exposure to cues outside of conscious awareness, and altered perceptions of internal responses and cognitive performance," said Nora D. Volkow, Director of NIDA, who will serve as a discussant at the symposium. "This knowledge will lead to the development of more responsive, integrated treatments."



Brookhaven's Goldstein explains the idea of impaired insight and how it might relate to drug addiction: "Patients suffering from mental illnesses such as schizophrenia often have compromised awareness of their own symptoms and the severity of their disorder. This compromise can exacerbate symptoms and reduce responsiveness to or compliance with treatment," she said. This "insight deficit" appears to originate from impairments in many of the same brain regions that underlie addiction symptoms - such as continued drug use despite catastrophic consequences, even when the drug is no longer pleasurable.



"It is therefore possible that these core clinical addiction symptoms - craving and compulsion and the chronic relapsing nature of addiction - may be a consequence of compromised insight," Goldstein said. Such impaired insight might help explain why drug-addicted patients often have a hard time recognizing, accepting, and/or acknowledging their own signs and symptoms of addiction, as well as the need for treatment. It could also help explain these patients' failure to comply fully with treatment regimens - and their tendency to relapse.



"Deficits in insight and interoception [sensitivity to the body's internal signals] and emotional awareness have largely been ignored in the field of addiction, despite the fact that this disorder is finally recognized as a disease of the brain, amenable to intervention and treatment," Goldstein said. "My hope is that this symposium will help bridge this gap and contribute to the design of new diagnostic tools and treatment approaches, pointing us toward more effective intervention strategies to improve prognosis in this illness."
















Symposium speakers were:
A. D. (Bud) Craig, Atkinson Research Laboratory, Barrow Neurological Institute, will discuss the role of the specific brain regions in insight and interoception in healthy states and in psychopathology.


Antoine Bechara, University of Southern California, will discuss the brain regions involved in impaired awareness of nicotine craving and concern about the potential long-term consequences in cigarette smoking.


Hugh Garavan, School of Psychology & Institute of Neuroscience, Trinity College, Dublin, will discuss the role of specific brain regions in blunted awareness to errors and compromised behavioral and situational monitoring in cocaine addiction, compromises that could precipitate excessive, unintended use or relapse.


Anna Rose Childress, Department of Psychiatry, University of Pennsylvania School of Medicine, will discuss how subcortical brain regions respond to drug-related stimuli, even without conscious awareness, and how these brain responses can predict emotional reactions and behavior in drug addiction.


Nora D. Volkow, Director of NIDA, will summarize and draw connections between these research areas.

The Society for Neuroscience will highlight this symposium and other addiction talks at a press conference titled "Why Can't I Forget My Last Fix?" on Monday, November 17, 2008, 3:30 - 4:30 p.m. at the Washington Convention Center.







Rita Goldstein's work at Brookhaven Lab is funded by the DOE's Office of Science and by NIDA.



Source: Karen McNulty Walsh


DOE/Brookhaven National Laboratory

Texas Officials Studying Needle-Exchange Program; District Attorney Says People Distributing Needles Do Not Have Immunity

Health officials in Bexar County, Texas, are considering if they should launch the state's first needle-exchange program in an effort to reduce the spread of HIV and other bloodborne diseases, but Bexar County District Attorney Susan Reed has said that she will not hesitate to prosecute anyone who distributes needles before the program is approved, the Los Angeles Times reports (Bustillo, Los Angeles Times, 1/28).

The Bexar County Commissioners Court in August 2007 unanimously voted to move forward with a pilot initiative to establish the program. The court voted to approve spending $60,000 for a staff position and planning costs for the program. The program likely will cost more when it begins operations, and organizers plan to seek funding from private groups to offset costs.

The Texas House in May 2007 voted 71-60 to approve a provision in a Medicaid bill (SB 10) that would establish the state's first needle-exchange program in Bexar County, which includes San Antonio. Rep. Ruth McClendon (D), who sponsored the provision, initially tried to add an amendment that would have created a statewide program. However, the program was limited to the San Antonio area after the broader program failed to gain support in the House. Following the vote from the County Commissioner's Court, Reed recently said that the law authorizing the exchange program is faulty (Kaiser Daily HIV/AIDS Report, 8/20/07). The Texas attorney general is reviewing the situation, according to the Times.

Texas is the only state nationwide that does not have a needle-exchange program, the Times reports. Reed, who is opposed to the initiative, said that people who distribute needles before the program is approved do not have "any kind of criminal immunity." San Antonio police earlier this month arrested three individuals from the Bexar Area Harm Reduction Coalition for distributing needles to injection drug users and commercial sex workers, the Times reports (Los Angeles Times, 1/28).

Related Editorial
The recent arrests make a "mockery of clear thinking in this state when it comes to containing infectious disease among" IDUs, a Houston Chronicle editorial says, adding that Reed is doing "her best to thwart" the initiative. The Texas Legislature should "revisit this issue in the next legislative session," the Chronicle says. Texas "needs a fully funded, statewide needle-exchange program run by local public health officials," the editorial says, adding that the state should "protec[t]" people who provide clean needles from "overly aggressive prosecutors" (Houston Chronicle, 1/28).


Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Alcohol Activates Cellular Changes That Make Tumor Cells Spread

Alcohol consumption has long been linked to cancer and its spread, but the underlying mechanism has never been clear.


Now, researchers at Rush University Medical Center have identified a cellular pathway that may explain the link.


In a study published in the current issue of Alcoholism: Clinical and Experimental Research, the researchers found that alcohol stimulates what is called the epithelial to mesenchymal transition, in which run-of-the-mill cancer cells morph into a more aggressive form and begin to spread throughout the body.


"Our data are the first to show that alcohol turns on certain signals inside a cell that are involved in this critical transition," said Christopher Forsyth, PhD, assistant professor of medicine and biochemistry at Rush University Medical Center and lead author of the study.


The epithelial-to-mesenchymal transition is a hot area of research right now, implicated in the process whereby cancer cells become metastatic. A large body of laboratory and clinical research suggests that it plays a key role in making cancer cells aggressive.


"Cancer cells become dangerous when they metastasize," Forsyth said. "Surgery can remove a tumor, but aggressive tumor cells invade tissues throughout the body and take over. If we can thwart this transition, we can limit cancer's toll."


The researchers treated colon and breast cancer cell lines with alcohol and then looked for the biochemical hallmarks of the epithelial-to-mesenchymal transition, including evidence of a transcription factor called Snail and of the receptor for epidermal growth factor. Snail controls the epithelial-to-mesenchymal transition; when overexpressed in mice, it induces the formation of multiple tumors. Epidermal growth factor is required by many cancer cells. "They need lots of it," Forsyth said. "They are addicted to it."


Laboratory tests showed that alcohol activated both these and other biochemicals characteristic of the epithelial-to-mesenchymal transition. Tests also demonstrated that the alcohol-treated cells had lost their tight junctions with adjacent cells, a preparation for migrating, as metastatic cells do.


In addition, Forsyth and his colleagues found that the same roster of biomarkers was activated in normal intestinal cells treated with alcohol, suggesting that alcohol not only worsens the profile of existing cancer cells but also may initiate cancer by stimulating the epithelial-to-mesenchymal transition.


Other researchers at Rush involved in the study were Yueming Tang, PhD, Maliha Shaikh, MS, Dr. Lijuan Zhang and Dr. Ali Keshavarzian. Research support was provided in part by the National Institutes of Health.


About Rush:


Rush University Medical Center includes a 674-bed (staffed) hospital; the Johnston R. Bowman Health Center; and Rush University (Rush Medical College, College of Nursing, College of Health Sciences and the Graduate College).


Rush is currently constructing a 14-floor, 806,000-square-foot hospital building at the corner of Ashland Avenue and Congress Parkway. The new hospital, scheduled to open in 2012, is the centerpiece of a $1-billion, 10-year campus redevelopment plan called the Rush Transformation, which also includes a new orthopedics building (to open in Fall 2009), a new parking garage and central power plant completed in June 2009, renovations of selected existing buildings and demolition of obsolete buildings. The new hospital is being designed and built to conserve energy and water, reduce waste and use sustainable building materials. Rush is seeking Leadership in Energy and Environmental Design (LEED) gold certification from the U.S. Green Building Council. It will be the first full-service "green" hospital in Chicago.


Rush's mission is to provide the best possible care for our patients. Educating tomorrow's health care professional, researching new and more advanced treatment options, transforming our facilities and investing in new technologies all are undertaken with the drive to improve patient care now, and for the future.


Source: Rush University Medical Center

Does Prenatal Binge Drinking Harm The Developing Fetus? Evidence Is Scarce

The evidence that binge drinking during pregnancy harms the developing fetus is very limited, according to an article published in the Journal of Epidemiology and Community Health (BMJ). There is clearer evidence that regular heavy drinking during the pregnancy is linked to a higher risk of birth defects. However, what impact binge drinking might have, without heavy regular drinking, is unclear, write the authors.


In this article binge drinking means consuming at least five alcoholic drinks in one sitting - approximately 7.5 units or 60 g of alcohol.


The authors' findings come after a comprehensive review of published studies on binge drinking among both pregnant women and those trying to get pregnant. The studies spanned 35 years, 1970-2005, and included over 3,500 articles. The researchers made a shortlist of the 14 most relevant studies. These 14 studies, say the researchers, were of good quality, but did have some methodological flaws.


They found scarce substantive evidence that binge drinking might cause miscarriage, stillbirth, birth defects, abnormal birthweight, or fetal alcohol syndrome. Although very limited data pointed towards a higher risk of impaired neurodevelopment, these effects were not significant and included disinhibited behavior, reduced verbal IQ, a higher risk of delinquent behavior later in life, and poor academic performance.


The researchers suggest that when the binge drinking takes place may be important, and point to the first 13 weeks of pregnancy as the most impacting on the embryo.


The authors explained "This systematic review found no convincing evidence of adverse effects of prenatal binge drinking, except possibly on neurodevelopmental outcomes."


They suggested that additional research is needed, and urged women to avoid binge drinking during their pregnancies as a precaution.


"When pregnant women report isolated episodes of binge drinking in the absence of a consistently high daily alcohol intake, as is often the case, it is important to avoid inducing unnecessary anxiety, as, at present, the evidence of risk seems minimal," they concluded.


"Systematic review of the fetal effects of prenatal binge drinking"

Jane Henderson, Ulrik Kesmodel, Ron Gray

J Epidemiol Community Health 2007; 61: 1069-75

doi:10.1136/jech.2006.054213

Click here to view Abstract online


Written by??

Raptor Pharmaceuticals Corp. Initiates Phase IIa Clinical Study For Convivia(TM)

Raptor
Pharmaceuticals Corp. ("Raptor" or the "Company") (OTC Bulletin Board:
RPTP), announced that its clinical development subsidiary, Bennu
Pharmaceuticals Inc. ("Bennu"), has initiated the Company's first
clinical-stage program after dosing the first cohort in a Phase IIa study
of oral 4-methylpyrazole ("4-MP") in subjects with ALDH2 deficiency, or
ethanol intolerance, as the initial development stage of its Convivia(TM)
program. Convivia(TM) is Bennu's proprietary, oral formulation of 4-MP
designed to reduce peak systemic acetaldehyde levels in ALDH2 deficient
persons following alcohol consumption.


ALDH2 deficiency, sometimes referred to as "Asian flushing syndrome,"
is an inherited metabolic disorder affecting 40% to 50% of East Asian
populations, impairing the activity of the liver enzyme aldehyde
dehydrogenase ("ALDH2"). When people with ALDH2 deficiency drink alcoholic
beverages, there is an accumulation of acetaldehyde, a carcinogenic
intermediate in the metabolism of ethanol, in blood and tissues. Published
retrospective studies have observed a significant correlation between
recurrent drinkers with ALDH2 deficiency and an increase in risk for
digestive tract cancers, liver diseases, late-onset Alzheimer's disease and
other serious health disorders. In addition to the long-term health risks,
elevated acetaldehyde levels produce acute symptoms, including facial
flushing, tachycardia (rapid heart rate), headache, nausea and dizziness.



Although ALDH2 deficient people suffer from unpleasant reactions and
face long-term health risks, a substantial proportion of them are recurring
drinkers of alcoholic beverages. Currently there are no approved treatments
for ALDH2 deficiency, and people with this disorder could potentially
benefit from a treatment that reduces acetaldehyde toxicities.



Convivia(TM) is designed to reduce peak systemic acetaldehyde levels in
ALDH2 deficient persons following alcohol consumption. 4-MP, the active
ingredient in Convivia(TM) and used in this Phase IIa study, is
FDA-approved in an injectible formulation for other indications, but is
investigational for treatment of acetaldehyde toxicities associated with
ethanol exposure in ALDH2 deficient subjects.



Ted Daley, president of Bennu, stated, "ALDH2 deficiency is fueling a
public health concern among clinical geneticists within the Asian medical
community, which underscores the need to address this patient population
with an effective treatment option. Although the risks of cancers and other
health problems associated with this disorder have been documented in
numerous studies over the past several years, they are not widely known to
the general population or to the substantial proportion of Asians who are
at risk. Even light to moderate ethanol intake may expose people with this
condition to increased risks for serious diseases without them realizing
it."
















Phase IIa Clinical Trial of Oral 4MP

One-Third Of Sexually Active Older Adults With HIV/AIDs Has Unprotected Sex

One out of three sexually active older adults infected with HIV has unprotected sex, according to a study by Ohio University researchers. A survey of 260 HIV-positive older adults found that of those having sex, most were male, took Viagra and were in a relationship.



AIDs cases among the over-50 crowd reached 90,000 in 2003. According to the Centers for Disease Control and Prevention, they will account for half of all HIV/AIDS cases in the United States by 2015 because medical intervention has extended the lifespan of those infected with HIV. Additionally, drugs such as Viagra have made it possible for older adults to remain sexually active longer.



Past studies have shown that up to 65 percent of older adults ages 60 to 71 have sexual intercourse. Among older adults who are HIV-positive, according to the Ohio University findings, 38 percent are sexually active.



"Those who are more likely to engage in riskier behavior - for example, those who are using drugs - are more likely to have unprotected sex," said graduate student Travis Lovejoy, who led the study along with Ohio University health psychologist Timothy Heckman. "What we don't know yet is whether these individuals are in a monogamous relationship with someone else who is HIV positive and believe there is no risk of infection."



The study also found that sexual activity was more prevalent among HIV-positive older adults who were not cognitively impaired, were younger and who considered their overall health to be good.



Because many older adults with HIV are not sexually active, those who do have unprotected sex account for just 13 percent of the overall number of infected people who are aged 50 or older. However, one-third of those who are sexually active have unprotected sex, which suggests that prevention efforts may need to be more highly targeted toward these individuals.



The behavioral information was pulled from a survey of 260 HIV-positive older adults who were participating in a study examining support groups. The study was funded by a three-year, $1.8 million grant from the National Institute of Mental Health and the National Institute of Nursing Research.



Lovejoy presented the findings at the annual conference of the Society of Behavioral Medicine.





Contact: Andrea Gibson


Ohio University



View drug information on Viagra.

Listen To Your Heart When It Comes To Substance Abuse And Mental Health

The Substance Abuse and Mental Health Services Administration (SAMHSA) would like to remind Americans that substance abuse and mental health problems affect those with heart disease. In fact, nearly a million Americans experiencing a serious psychological disorder in the past year also suffered from heart disease.


Similarly more than a quarter of a million Americans who had a substance abuse disorder in the past year also experienced heart disease.


So it's important for the health of your heart as well as your overall wellbeing that you seek help for any substance abuse or mental health problems you may be facing. By getting treatment you can lead a longer and happier life.


To access information on the mental health treatment services in your area go here.


For substance use treatment providers in your area you can go here.


Source
Substance Abuse and Mental Health Administration (SAMHSA)

Nurses: Mandatory Code Needed To Tackle Alcohol Harm, UK

The Royal College of Nursing welcomed a new Department of Health campaign to combat excessive drinking as it responded to news from the Office of National Statistics that the number of deaths caused by alcohol consumption is continuing to rise.



Dr Peter Carter, Chief Executive & General Secretary of the Royal College of Nursing (RCN), said:


"Nurses see the devastating consequences of alcohol misuse everyday, and have consistently warned about the hidden dangers of drinking too much. It is an absolute tragedy that every year more and more people are dying as a result of excessive drinking.


"It is vital that people are made aware of the dangers of excessive drinking through effective and widespread education initiatives such as the new campaign launched today by the Department of Health. However, education is just part of the package needed to stop people damaging their health as a result of drinking too much. Longer term solutions are needed to change the nation's historically permissive attitude towards alcohol. That is why the RCN is calling for a mandatory code which would introduce tighter regulation of the advertising, labelling and sale of alcohol.


"As we approach the general election, all parties must make a firm commitment to take drastic action to prevent more people suffering as a result of excessive drinking."


Source

Royal College of Nursing

Time Examines Efforts To Curb HIV/AIDS In China

Time on Wednesday examined China's efforts to curb the spread of HIV/AIDS and address the rising number of related deaths in the country. China announced in February that HIV/AIDS was the country's No. 1 deadly infectious disease in 2008, resulting in almost 7,000 deaths in the first nine months of last year. Time reports that the "fact that HIV ... is a significant and increasing cause of death" in the country "shows that government programs are not reaching enough people." Bernhard Schwartlander, coordinator of UNAIDS in China, said that it is "very difficult" to discuss sex in China's schools, workplaces and relationships. He added, "If they don't know about it, how can they protect themselves?"

According to Time, UNAIDS reports that at the end of 2007, about 700,000 people were living with HIV in China, with about 85,000 cases having progressed to AIDS. Although that statistic "isn't staggering ... the potential for things to get worse is alarming," Time reports. Schwartlander said, "For a long time China missed the opportunity to tackle AIDS head on. They tried to avoid it and I think they really ignored the problem." UNAIDS estimates that China's AIDS awareness programs currently reach between 20% and 40% of the country's at-risk communities, such as commercial sex workers, injection drug users and men who have sex with men. Schwartlander said that the "big question" regarding China's HIV/AIDS efforts is how to "make sure these good, sensible policies and ideas are really implemented throughout the whole country," which has a population of about 1.3 billion. He said policies that are implemented in China's urban areas, such as Beijing, have to be effectively implemented in the country's rural areas and communities, where 60% of the population lives. "Unless you understand how you can translate the policies into the realities of where the people are living, you will not succeed," Schwartlander said, adding, "There's an opportunity here to make sure 50 million people don't become infected" (Webley, Time, 4/8).


Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Need A Cigarette And A Cocktail? Just Pop A Pill Instead

Smoking and drinking are two vices that often go hand in hand (one hand clutching a drink while the other holds a smoke). A decade ago, a study in the Journal of Studies on Alcohol indicated that as many as 85 percent of heavy drinkers also light up. Smokers have various aids to help them quit the deadly habit, including varenicline, a drug manufactured by Pfizer that blocks nicotine from releasing the pleasure-associated neurotransmitter dopamine. Now new studies in rats show that it also blocks a craving for alcohol.


Eighteen rats were given intermittent access to 40 proof alcohol for four months. By varying access to the liquor this way, pharmacologist and alcohol researcher Selena Bartlett of the Ernest Gallo Clinic & Research Center at the University of California, San Francisco, and her colleagues made rats crave it. Every time the rodents had access to booze, they upped their intake. "They drink all day and then they don't get to drink," Bartlett says. "The withdrawal makes them want to drink more."


But even after months of this behavior - 37 binge-drinking sessions in all - the rats cut their drinking in half when given varenicline. And when taken off the drug, the rats did not immediately imbibe more (the so-called rebound effect that has plagued other treatments). "That's because we believe [the drug] is turning down the reward system," Bartlett says, "instead of replacing the system."



Bartlett believes that varenicline works by fastening onto receptors in the brain that would otherwise be activated by alcohol (or nicotine). A synthetic drug - modeled after the alkaloid cytisine from the small flowering Laburnum trees of Europe chemically combined with a compound from the poppy plant - it also curbed drinking in seven rats with continuous access to alcohol and 30 rats trained to self-administer liquor when stressed.


Varenicline has been available as a smoking cessation aid for nearly a year in the U.S. and the European Union, 30 countries in all. In addition to already having proved its safety in humans, the drug offers other benefits over current alcoholism treatments, including not diminishing appetite. Also, "it's not metabolized in the liver," Bartlett says, a major plus because "people who have been drinking for a long time tend to have liver damage."


The researchers plan to conduct clinical trials on humans pending permission and funding by the U.S. National Institute on Alcohol Abuse and Alcoholism in Bethesda, Md. It remains unclear how long a treatment would need to be in order to kick the habit but the drug does linger longer in the human system. "In rats, the drug only lasts for a few hours," Bartlett says, although it still cuts drinking in half. "In humans, it lasts 24 hours." And some alcoholics who are trying to quit smoking may already be feeling the benefits.


"Smokers who use the drug varenicline to help them stop lighting up may discover it also reduces their urge to drink"

By David Biello

Scientific American

Click here to see article online

Opioid Prescribing At Forefront Of Pain Medicine Meeting

Opioid therapy, opioid prescribing and prescription drug diversion were provoking topics at the 23rd annual meeting of the American Academy of Pain Medicine (AAPM) at the Hilton New Orleans Riverside Hotel/Morial Convention Center, February 7-10, 2007.



Opioid treatment is an essential component of pain care for many patients and can be delivered safely and effectively, according to Frederick Burgess, M.D., Ph.D., AAPM president, who estimates that 20 to 60 million Americans live with chronic pain.



Prescription Drug Diversion



A common goal of both physicians and law enforcement is to maintain an appropriate balance between preventing the illegal diversion of drugs while safeguarding the needs of legitimate pain patients, according to the experts speaking at the "Pain Medicine and Law Enforcement: Achieving a Team Approach" session.



"Physicians have nothing to fear from the Drug Enforcement Administration (DEA) in their legitimate practice of medicine," says Mark W. Caverly, who is chief of the liaison and policy section in the DEA Office of Diversion Control. "The DEA's guiding principle is to prevent the diversion and abuse of pharmaceutical controlled substances without impacting the ability of patients with legitimate need to have full access to pain relief as prescribed by their physician. The DEA's responsibility is to enforce the law, not dictate the practice of medicine," concludes Caverly, who will represent the DEA during the Pain Medicine and Law Enforcement session.



Caverly also discussed the legal standards of prescribing as set forth in the Controlled Substances Act, the proposed rule to allow multiple prescriptions for schedule II controlled substances, and upcoming policy/regulation topics.



In the same session, John Burke, who is president of the National Association of Drug Diversion Investigators, addressed prescription drugs of abuse and related diversion scams.



"Knowing what the current drug diversion scams are can help physicians decide who is trying to take advantage of them," says Burke, commander of the Warren County Drug Task Force in the Cincinnati area of southwest Ohio. "The vast majority of patients are not drug seekers and that is where the balance comes in. We do not want to deprive legitimate patients effective pain relief through legally prescribed medications because of the acts of a relative few."



"Today, pain medicine specialists are concentrating on the development of the best scientific and clinical protocols for opioid use," Dr. Burgess comments. Opioid treatment was addressed at the meeting in a number of scientific sessions, poster presentations and scientific abstracts.



Other Program Highlights:



Cannabinoids - A New Class of Analgesics

Four Decades of Neuromodulation

Pain Medicine and Law Enforcement: Achieving a Team Approach

Medical Conditions for Patients With Pain After Natural Disaster

Opioids: Good or Bad?

Ethical Medical Practice and Managed Care: An Oxymoron?

Breaking Concepts in Diagnosis and Treatment of Complex Regional Pain Syndromes




"The AAPM annual meeting is a gathering of pain medicine experts from across the country who spend three days together sharing information about the latest research, patient care, and regulatory issues that affect the practice of Pain Medicine," says Dr. Burgess.
What are Opioids?
For more information on what opioids are, and opioid-induced constipation (OIC), please see:
All About Opioids and Opioid-Induced Constipation (OIC)



Founded in 1983, AAPM is the medical specialty society representing physicians practicing in the field of pain medicine. The Academy is involved in education, training, advocacy and research in the specialty of pain medicine. Information is available on the practice of pain medicine at painmed/.



Contact: Amy Jenkins


American Academy of Pain Medicine

Study: Victorians Aren't Aware Alcohol Causes Cancer

Call on govt review panel for better alcohol labeling
VIC: Research released today shows half of all Victorians don't realise that alcohol causes cancer, prompting the
Alcohol Policy Coalition to call for health advisory labels on all alcohol products to better inform consumers.


The Council of Australian Governments is today holding a public meeting in Melbourne to discuss overhauling
Australia's food and alcohol labelling laws.


"People need to know what they are drinking and how it can impact their health so that they can make an informed
decision about the drinks they purchase and consume," said Craig Sinclair, Director of the Cancer Prevention
Centre, Cancer Council Victoria.


The VicHealth survey of 1,500 Victorians showed one in four people don't believe that alcohol is a cause of cancer,
while another twenty-five percent said they weren't sure.


"It's surprising that there isn't even a requirement for alcohol companies to list ingredients on their products, let
alone labels about the risk of disease. There is no reason why alcohol, which is inherently harmful, is subject to
less regulation in this regard than a can of soft drink," said Mr Sinclair.


Previously released figures from VicHealth showed that 85 percent of people support the introduction of labels
detailing health information on alcohol products, which are already a requirement in at least 43 countries.
"We call on the Council of Australian Governments through the labelling review to make health information and
warning labels mandatory rather than through a voluntary system implemented by the alcohol industry.
"The tobacco labelling success has proven that health labels play a big part in changing the behaviour of
consumers. Similarly health labels will assist people to understand the potential health impact when they buy
alcohol and when they drink it," said Mr Sinclair.


Alcohol is second only to tobacco as the most harmful drug in Australia. The World Health Organisation has
classed alcohol as a Group 1 carcinogen, which is the highest classification. This means that alcohol is a cause of
cancer and puts alcohol in the same class as tobacco. Drinking alcohol increases the risk of cancers of the


- mouth

- throat (larynx and pharynx)

- oesophagus

- bowel (colon and rectum)

- liver

- female breast.



The risk of cancer is present for all types of alcohol including beer, wine and spirits.
In 2005, 3,000 Australians were diagnosed with an alcohol-related cancer and 1,376 died from cancers caused by
alcohol.


The Alcohol Policy Coalition (the Coalition) is a collaboration of health agencies - Australian Drug Foundation, Cancer Council Victoria, Turning
Point Alcohol and Drug Centre and VicHealth - with shared concern relating to the misuse of alcohol and its health/social impacts on the
community. Alcohol remains one of the major causes of preventable death and illness in Australia. As such, the Coalition advocates for
evidence based policy to prevent and reduce the harms caused by alcohol to Australians. For more information visit
alcoholpolicycoalition.au

Source
Australian Drug Foundation

Smoking May Interfere With Alcoholics' Neurocognitive Recovery During Abstinence

* Alcoholics frequently smoke.

* Many alcoholics in treatment continue to smoke.


* New findings indicate that smoking may interfere with alcoholics' neurocognitive recovery during their first six to nine months of alcohol abstinence.



Alcoholics frequently smoke. Anywhere from 50 to 90 percent of individuals in North America who seek alcoholism treatment are also chronic smokers. New findings indicate that smoking may interfere with alcoholics' neurocognitive recovery during their first six to nine months of abstinence from alcohol.



Results are published in the July issue of Alcoholism: Clinical & Experimental Research.



"There are several possible explanations for the concurrent use of alcohol and tobacco products," said Timothy C. Durazzo, assistant adjunct professor in the department of radiology at the University of California San Francisco, and corresponding author for the study. "Nicotine and alcohol may enhance each other's rewarding properties; nicotine may decrease some of alcohol's negative effects on cognition and motor incoordination; paired use of nicotine and alcohol may produce a strong association between the two substances such that the use of one leads to cravings for the other; and there may exist a genetic vulnerability for concurrent active cigarette smoking and alcohol dependence."



Durazzo added that previous research had shown that chronically smoking alcoholics demonstrate poorer performance in multiple areas of cognitive functioning than non-smokers when they are still actively drinking or after a short period of sobriety. "However, it was unknown if non-smoking alcoholics and alcoholics who continued to smoke during abstinence would show comparable levels of recovery after a sustained period of sobriety," he said.



Study authors recruited three groups: 13 non-smoking recovering alcoholics (12 males, 1 female), 12 actively smoking recovering alcoholics (11 males, 1 female), and 22 non-smoking light-drinking 'controls' (20 males, 2 females). The researchers examined neurocognitive changes that occurred in the two recovering-alcoholic groups during six to nine months of abstinence from alcohol, comparing their neurocognitive performance with that of the controls.



"Non-smoking alcoholics showed a significantly greater level of recovery than smoking alcoholics in the areas of mental efficiency, higher-level reasoning and problem-solving, visual-spatial processing skills, and working or short-term memory," said Durazzo. "Although smoking alcoholics in the study improved significantly in auditory-verbal memory and processing speed over six to nine months of abstinence from alcohol, the level of their recovery was not greater than the non-smoking alcoholics. It is also of note that in the smoking alcohol group, those with greater nicotine dependence and longer smoking histories showed less recovery in several areas of functioning."
















"In short, abstinent alcoholics without a history of cigarette smoking achieved better recovery of critical mental functions during the first six to nine months of sustained sobriety," said Sara Jo Nixon, a professor in the department of psychiatry at the University of Florida. "[These] differential outcomes demonstrate the importance of considering the behavioral impact of continued cigarette smoking among alcoholics on long-term recovery of function."



Durazzo concurred. "Previous research on neurobiological and cognitive recovery from chronic alcoholism has not considered the potential impact of cigarette smoking on recuperation," he said. "Furthermore, most research investigating the health consequences of chronic cigarette smoking has focused on increased risk for various forms of cancer and the cardiovascular, cerebrovascular, pulmonary ramifications. Given that the mortality associated with cigarette smoking is nearly four times greater than the mortality related to alcohol-induced diseases, and given our findings - perhaps chronic smokers entering treatment for substance abuse and alcoholism should consider concurrent participation in a smoking-cessation program."



"This study did not include a group of alcoholics who had quit smoking at the time of discontinuing alcohol use," noted Nixon, "but these data suggest this would be an important study. It is [also] important that the current study was almost exclusively male. Given the growing literature regarding female smokers, additional studies including women should be conducted. Finally, as the authors note, the observed differences are not likely associated with nicotine, per se. Rather, they are associated with exposure to the many toxins in smoke. This distinction is critical in considering individual options for nicotine cessation."



"Even though our results should be considered preliminary," said Durazzo, "they suggest that consideration of smoking status is relevant to the assessment of cognitive recovery. More generally, chronic smoking may impact neurocognition in other conditions where is it a prevalent behavior, such as schizophrenia-spectrum and mood disorders. Further research is imperative."






Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "Chronic Smoking is Associated with Differential Neurocognitive Recovery in Abstinent Alcoholics: A Preliminary Investigation," were: Johannes C. Rothlind and Peter Banys of the San Francisco Veterans Administration Medical Center and the Department of Psychiatry at the University of California San Francisco; Stefan Gazdzinski of the San Francisco Veterans Administration Medical Center and the Northern California Institute for Research and Education; and Dieter J. Meyerhoff of the San Francisco Veterans Administration Medical Center, the Northern California Institute for Research and Education, and the Department of Radiology at the University of California San Francisco. The study was funded by the National Institutes of Health.



Contact:



Timothy C. Durazzo, Ph.D.

San Francisco Veterans Administration Medical Center



Sara Jo Nixon, Ph.D.

University of Florida




Alcoholism: Clinical & Experimental Research

Gene Variation Makes Alcoholism Less Likely In Some Survivors Of Sexual Abuse

Exposure to severe stress early in life increases the risk of alcohol and drug addiction. Yet surprisingly, some adults sexually abused as children - and therefore at high risk for alcohol problems - carry gene variants that protect them from heavy drinking and its effects, according to researchers at Washington University School of Medicine in St. Louis.


The researchers, from the university's Midwest Alcoholism Research Center, say the finding could aid the development of therapies for alcohol dependence by offering suggestions for targeted treatments based on genetic traits and history of exposure to severe stressors.


Scientists estimate that about half the risk for alcoholism is encoded in a person's genes. The rest comes from environmental factors, such as age at first drink and exposure to extreme stress. Other research has suggested that when the environmental risk factors occur during key periods of brain development, genes and environment working together can increase the likelihood an individual will become alcohol dependent. Child sexual abuse is one of the environmental stressors that can interact with genes to significantly increase the risk for alcohol problems.


But the researchers report in the January issue of Addiction Biology that people with a particular pattern of genetic markers seem to be protected against alcohol problems, even if they were sexually abused as children.


Those who were protected carry a set of genetic variations that scientists call the H2 haplotype. Similar to a blood type, a haplotype is more than just a single genetic mutation. It is a normally occurring pattern of gene variants that are statistically associated with one another so that when scientists find a few genetic markers, they can successfully predict what other genetic variations will occur within a particular region of DNA.


"We looked at how genes and environment interact," says Elliot C. Nelson, M.D., lead author of the study. "Our analysis included both sexual abuse and information about the DNA region that carries the H2 haplotype. People who carry that genetic pattern were protected against the risks for alcohol consumption and alcohol dependence typically associated with sexual abuse."


Other sexual abuse victims in the study had the alternate genetic pattern known as the H1 haplotype. Those individuals had three times the risk of heavy drinking and alcohol dependence as those who had not been sexually abused.


"They drank much more alcohol and had a significantly greater risk for problems," says Nelson, an associate professor of psychiatry. "But abuse victims with the H2 haplotype seemed to be completely protected against those risks."















Nelson's team studied data from more than 1,100 people in 476 Australian families who participated in the Nicotine Addiction Genetics project. Originally, that study was set up to learn about nicotine addiction, but investigators also looked at related problems, including how much alcohol people drank and whether they met the diagnostic criteria for alcohol dependence.


Study subjects also were asked about sexual abuse in childhood. A total of 121 women and 35 men reported a history of sexual abuse beginning at around age 11. Nelson's group also had access to DNA samples from those evaluated in this study.


By identifying a handful of specific sites in the genome, it's possible to classify a person as having either the H1 or the H2 haplotype. One of the genes in the DNA region included in H1 and H2 is called corticotropin releasing hormone receptor type 1 (CRHR1). Nelson's group is focusing on that gene, which research in animals has implicated in risk for alcohol dependence.


Many past studies have focused on genes related to alcohol metabolism, but CRHR1 is not a metabolism gene. Nelson says it appears from animal studies, however, that the gene may be involved in risks associated with the effects of environmental stress. In the case of humans, he suspects variants of the gene may play a role in protecting against stresses caused by child sexual abuse.


"There are many different ways an individual can become alcoholic, some involving heavy genetic risks, some involving specific environmental factors, such as exposure to peers who drink heavily," Nelson says. "This particular pathway involving CRHR1 is interesting because it seems to play an extremely important role in animal models of alcohol consumption and dependence."


He says better understanding of how the gene works may help scientists understand the process by which people become alcoholics. As they attempt to clarify the possible role of the CRHR1 gene in protecting sexual abuse survivors from alcohol dependence, Nelson says it may be interesting to look at other severe environmental stressors that trigger alcohol use to see whether people with the H2 variation also are protected from those forms of risk.


In addition, he says drugs have been developed that block CRHR1 receptors. If it turns out that humans are responding to the same stressors and reacting via the same genetic pathway that animals do, Nelson says some of those drugs may be able to help people who are alcoholic using the same pathway that protects people with the H2 haplotype.


A panel of leading alcoholism researchers will discuss important findings from translational and other genetic research and their implications for treatment at Washington University School of Medicine during the 10th annual Guze Symposium on Alcoholism. The topic of the Feb. 18 meeting is Disentangling the Genetics of Alcoholism: Understanding Pathophysiology and Improving Treatment.


Nelson EC, Agrawal A, Pergadia ML, Wang JC, Whitfield JB, Saccone FS, Kern J, Grant JD, Schrage AJ, Rice JP, Montgomery GW, Heath AC, Goate AM, Martin NG, Madden PAF. H2 haplotype at chromosome 17q21.31 protects against childhood sexual abuse-associated risk for alcohol consumption and dependence. Addiction Biology, vol. 15 (1); pp. 1-11, Jan. 2010
doi:10.1111/j.1369-1600.2009.00181.x


This study was supported by the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health, the ABMRF/Foundation for Alcohol Research and the Australian NHMRC Fellowship Scheme.


Study authors Goate, Rice, Saccone and Wang are listed as inventors on a patent held by Perlegen Sciences Inc., covering the use of certain single nucleotide polymorphisms (SNPs) in determining the diagnosis, prognosis and treatment of addiction.


Source
Washington University in St. Louis

News From The Journal Of The National Cancer Institute, March 11, 2008

Radiation Exposure In Utero and in Young Children Increases Adult Cancer Risk



Radiation exposure before birth or during early childhood increased the risk of adult solid cancers, according to a study of survivors of the Hiroshima and Nagasaki bombings.



It is known that radiation exposure during fetal development increases the risk of childhood cancers and that exposure during early childhood increases the risk of adult-onset cancers. However it was not known if radiation exposure to the fetus increases the risk of adult cancers.



To find out, Dale Preston, Ph.D., of the Hirosoft International Corporation in Eureka, Calif., and colleagues at the Radiation Effects Research Foundation in Hiroshima, Japan, calculated the excess risk of solid cancers in adult survivors of the Hiroshima and Nagasaki bombings, relative to non-exposed populations.



Of the 2,452 study participants who were exposed to radiation before birth, 94 have developed adult cancers, as did 649 of the 15,388 individuals who were exposed between birth and six years of age. By age 50, the excess relative risk for those exposed before birth was 1.0 per Sv (a unit for measuring radiation exposure), and for those exposed as young children, it was 1.7 Sv at age 50.



The researchers note that the overall risk of solid cancers increases with age, and so continuing to follow the study participants as they age will be important. Also, the investigators only considered solid cancers, and did not examine the rate of blood cancers, such as leukemia.



"The present data suggested that increases in risks of adult-onset cancer among those exposed to radiation in utero may be smaller than for those exposed in early childhood," the authors write. That said, these data may be important when considering the public health risks of medical and occupational radiation exposure for pregnant women.



Contact: Dale Preston or Roy Shore, chief of research, Radiation Effects Research Foundation



Anchoring Protein Variant Associated with Increased Breast Cancer Risk



Individuals who carry a rare genetic variant have an increased risk of developing breast cancer over their lifetimes, compared with those who do not have the variant.



Few genes have been found to have a large impact on the risk of familial breast cancer, and researchers expect that most breast cancers are influenced by the combined effects of multiple genes, each of which has a small impact on its own. One of those genes may be AKAP9.



To determine whether a rare sequence variant of the AKAP9 gene increases the risk of breast cancer, Barbara Burwinkel, Ph.D., of the German Cancer Research Center in Heidelberg and colleagues compared the frequency of the variant in 9,523 breast cancer patients with its frequency in 13,770 healthy control subjects from a large international collaboration project.
















The team found that individuals who carry two copies of the rare variant have a 17 percent increased relative risk of developing breast cancer compared with those who carry two copies of the normal sequence. For those individuals who carry one copy of the rare variant and one copy of the normal sequence, their relative risk increased 10 percent over their lifetime.



"It is also of interest that this variant has previously been found to be associated with colorectal and lung cancer risk," the authors write.



Contact: Stefanie Seltmann



Sexual Activity and Marijuana Use Associated with HPV-Positive Head and Neck Cancer



The risk factors for human papillomavirus (HPV) type 16-associated head and neck cancer are different from those associated with head and neck cancers that do not express HPV. The two types of cancers should be considered distinct malignancies.



Scientists have recently discovered that HPV-16, which is known to cause cervical cancer, can also lead to head and neck cancers. It was not clear, however, whether previously identified risk factors for head and neck cancer, such as tobacco smoking and alcohol consumption, apply to the malignancies caused by the virus.



To find out, Maura Gillison, M.D., Ph.D., of the Johns Hopkins Kimmel Comprehensive Cancer Center in Baltimore and colleagues conducted a case-control study with 240 head and neck cancer patients and 322 matched control subjects. The team collected behavioral information using a computer-assisted self-interview technique. They also examined tumor samples from each patient to determine whether the cancer expressed HPV-16.



A total of 92 cancers (38 percent) were HPV-16 positive. HPV-positive cancers were associated with increasing numbers of oral sexual partners and with increased marijuana use. Smoking, alcohol consumption, and poor oral hygiene were not associated with HPV-positive cancers, but were associated with HPV-negative head and neck cancers.



"Our data support the existence of at least two etiologically distinct pathways for [head and neck cancer] pathogenesis, one mediated by tobacco and alcohol and the other by HPV," the authors write.



Contact: Vanessa Wasta, media relations, Sidney Kimmel Comprehensive Cancer Center



Overexpression of an Inflammatory Marker May Be Associated with an Increased Risk of Breast Cancer



Expression of the inflammatory protein, cyclooxygenase-2 (COX-2), in benign breast biopsy samples may be associated with an increased risk of a breast cancer diagnosis in the future.



Many breast biopsies uncover non-cancerous but abnormal tissue growth patterns, including atypical hyperplasia. Although women with such a diagnosis are at a higher risk of developing breast cancer in the future, not all of them will do so. Identifying ways to distinguish precancerous lesions from ones that will remain benign is important. One marker that has been associated with cancer development in animal models and some human cancers is COX-2.



Lynn Hartmann, M.D., of the Mayo Clinic in Rochester, Minn., and colleagues tested archival biopsy samples for expression of COX-2 and collected information on subsequent breast cancer diagnoses from medical records and a study questionnaire. The risk of developing breast cancer was compared with that of the general population.



A total of 235 women participated in the study, each of whom had been diagnosed with atypical hyperplasia between 1967 and 1991. After a median follow-up of 15 years, 41 women had developed breast cancer. The risk of a breast cancer diagnosis increased with the intensity of COX-2 expression in the initial biopsy sample. The trend of increasing risk with increasing expression intensity was of borderline statistical significance. For those with the highest level of expression, the risk rose 5.66-fold, from an expected 1.6 cases of breast cancer to nine observed cases.



These data, together with other studies in breast cancer, suggest COX-2 "may be a relevant target for chemoprevention strategies," the authors write.



Also in the March 11 JNCI:



* Survival In Gastric Cancer Patients Not Improved By Postoperative Chemotherapy



* Better Survival In Dutch Ovarian Cancer Patients When Treated At Specialized Hospitals







Source: Liz Savage


Journal of the National Cancer Institute

Launch Of Phase II Clinical Trial For TA-NIC, A Vaccine Treatment For Nicotine Addiction

Celtic Pharmaceutical Holdings L.P. ("Celtic Pharma") today announced that approval has been granted in the United Kingdom to start a Phase II trial of TA-NIC, a vaccine being developed for the treatment of nicotine addiction. The study is a placebo controlled, multicentre study, designed to assess the efficacy and safety of TA-NIC in maintaining smoking cessation when given in conjunction with current standard support treatments. Patient recruitment is scheduled to begin in the UK this quarter.



"We are excited to be commencing this study which intends to recruit over 400 patients in Europe and is a significant step on the development pathway for TA-NIC. If this study is successful, we plan to move aggressively to bring this exciting product to market as a novel therapeutic option for the management of smoking cessation," commented Dr. Patrick C. O'Connor, Head of Clinical Development at Celtic Pharma's development entity.


TA-NIC is a therapeutic vaccine in development for the treatment of nicotine addiction. Anti-nicotine antibodies, which the vaccine is designed to raise, bind to nicotine in the bloodstream. Since antibodies are too large to cross the blood-brain barrier, bound nicotine should be prevented from getting to the brain. Consequently, the pleasurable stimulus which usually accompanies smoking should be absent or reduced. Without this reward, the motivation to smoke again is expected to be reduced, diminishing the reinforcement required to maintain the nicotine addiction. In Phase I studies designed to test the safety and establish the optimal dose of TA-NIC, a reduction in pleasure from smoking as well as improved quit rates were observed in dose groups that induced the highest anti-nicotine antibody responses. Celtic is also developing a vaccine against Cocaine addiction, TA-CD, which shares a common technical platform with TA-NIC. Currently a Phase II study with TA-CD is nearing completion in patients with cocaine addiction.


About Celtic Pharmaceutical Holdings L.P.


Celtic Pharmaceutical Holdings L.P. is a global private equity investment firm focused on the biotechnology and pharmaceutical industries. Celtic Pharma was founded by Stephen Evans-Freke and John Mayo, CBE and is based in Bermuda, with offices in New York and London. Celtic Pharma acquires and invests in late stage pharmaceutical programmes and drives these programmes through the final stages of regulatory approval. Celtic Pharma's aim is to bridge the gap between the established pharmaceutical companies' new product pipeline crisis and the biotech industry's capital drought.

For further information, please visit Celtic Pharma's website at celticpharma.

New Jersey Gov. Signs Bill To Establish Needle-Exchange Programs In Six Cities, Provide $10M For Drug Treatment Programs

New Jersey Gov. Jon Corzine (D) on Tuesday signed into law a bill that allows six cities in the state to establish needle-exchange programs and provides $10 million to drug treatment programs in the state, the New York Times reports (Chen, New York Times, 12/20). New Jersey has the highest new HIV infection rate among women in the U.S. and ranks fifth in HIV prevalence in the country. In addition, it is the only state that does not allow injection drug users access to clean needles through community-based needle-exchange programs or with a prescription. According to the New Jersey Department of Health and Senior Services, 14% of new HIV/AIDS cases in the state in 2005 were attributed to injection drug use. The state health commissioner under the legislation must report to the governor and Legislature on whether the needle-exchange program is effective. In addition, people who participate in and run the program would be required to carry identification cards that protect them from being arrested for possessing drug paraphernalia. Officials from Atlantic City, Camden and Patterson have said they are interested in establishing a needle-exchange program (Kaiser Daily HIV/AIDS Report, 12/12). "It's long overdue," Corzine said at the bill signing, adding, "We need to protect those we don't know who have yet to be infected." According to Corzine, the needle-exchange program is "an opportunity to draw people into treatment" for drug addiction (DeFalco, AP/Philadelphia Inquirer, 12/19).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

New Alcoholic Anonymous Stories Speak Directly To Very Young Alcoholics

-- "If I could have stayed cool, I'd still be drinking. Very quickly, though, I started getting into trouble. Going to sixth grade got in the way of my life, which consisted of getting drunk as much as possible." [After rehab] "I was going to A.A. meetings. Everyone was older, even most of the kids at the young people meetings. But I found that alcoholics understand other alcoholics. . . . Regardless of how young or old or 'special' I am, in A.A. I'm just a drunk." Tina, who joined A.A. at 13


-- "I loved drinking and was as addicted to the lies, the shady people and places as I was to the alcohol. My grades suffered until I stopped going to school altogether. . . . I found myself in places without any idea of how I had gotten there. I overdosed on alcohol." Since coming to A.A., "I have been given an opportunity to grow up with the Twelve Steps in my life. It is with utmost gratitude that I have just celebrated my 19th year of continuous sobriety." Kevin, who joined A.A. at 14


Tina and Kevin are two of the 19 very young alcoholics who relate their experience as recovering alcoholics in a revised pamphlet just released by Alcoholics Anonymous: "Young People and A.A." Eight recollections by early teen and preteen alcoholics are included in the new edition, which also contains most of the original stories by alcoholics 25 and under.


The young A.A.s speak candidly about their preconceived notions of A.A. and what happened when they stepped tentatively into their first meetings. As Nicole, who sobered up at 14, says, "I knew A.A. held the solution to alcoholism. What I didn't know was that anyone old enough to have a problem is old enough to seek help from A.A."


Since the Fellowship began in 1935, the age of new members has constantly dropped. A.A. groups for young people began appearing as early as 1945 in Los Angeles, Cleveland and Philadelphia, and now can be found across the United States and Canada. Today approximately 10 percent of A.A. members are under 30.


In reaching out to young alcoholics, A.A. offers them a variety of special literature and audiovisual material, mainly available in Spanish and French as well as English. The stories help the young newcomer to A.A. understand that an alcoholic can "hit bottom" without going through 20-plus years of drinking, never mind the loss of family, friends and financial stability. Through identification with the recovery stories of people their own age, they learn they never have to feel so alone and frightened again - and can lead comfortable, happy, even exciting lives in sobriety.


Among other A.A. pamphlets that speak directly to young people are three in comic-book format: "Too Young," in which teenagers aged 13 to 18 share their drinking stories; the newly revised "It Happened to Alice," geared to young female alcoholics; and "What Happened to Joe," which tells the story of a young construction worker on the edge of alcoholic self-destruction. A counterpoint to the pamphlet "Young People and A.A." is the 28-minute video of the same name in which four young A.A. members tell the stories of their drinking and recovery in A.A., with closed captions for the deaf and hard-of-hearing.


To obtain a copy of the pamphlet "Young People and A.A." or other A.A. literature and service material, call your local A.A. Intergroup or Central Office. For further information about A.A. please contact the Public Information desk at the A.A. General Service Office, (212) 870-3119 or publicinfoaa.


alcoholics-anonymous

UK Government drug rehab figures 'inflated'

A former consultant at the UK Department of Health has accused health officials of "inflating" figures for treatment of
drug addicts.


The expert reportedly resigned from the drug treatment monitoring system after he was told it was "politically unacceptable"
for the Government to miss its target for the expansion of drug treatment places.


The un-named consultant alleges that political pressure led health officials to mislead ministers regarding the number of
problem drug users, including heroin and cocaine addicts, in treatment programmes, according to The Guardian.


In an article published in Druglink, the magazine of drug information charity Drugscope, the consultant claims he resigned
because, "I felt I was being pressured to give misleading information to MPs and morally I cannot accept that".


Six weeks ago, health officials published figures showing 154,000 problem drug users undergoing treatment in 2003-04. The
figures showed that the Government had hit its target to expand treatment places by 55 per cent in five years.



However, the National Treatment Agency (NTA) suggests that a more accurate figure for 2003-04 may be 125,900 "in contact with
treatment".


Paul Hayes, the NTA's chief executive, said: "Everyone knew that data collection methods in the treatment sector needed to be
improved. We stand by our figures and believe they continue to provide the most accurate reflection yet of the state of drug
treatment."


hda-online

60% Of HIV-Positive People In India Live In Rural Areas, WHO Report Says

About 60% of the approximately 5.2 million adults living with HIV/AIDS in India live in rural areas, according to a report recently released by the World Health Organization, PTI/Financial Express reports. According to the report, HIV prevalence among adults is about 1% in five of India's 35 states and territories. HIV prevalence among injection drug users in the country has increased from 7% in 2002 to 23% in 2005, the report said. In addition, the report found that HIV prevalence among commercial sex workers in Mumbai has remained between 40% and 50% during the past five years. The report also found that in 18 of 30 districts in the Indian state Maharashtra, HIV prevalence among women visiting government prenatal clinics was 1% or higher. Similar figures were recorded in 16 of 25 districts in Karnataka state, according to the report. The report also found that HIV prevalence among men who have sex with men is between 1% and 40% across 18 areas that have targeted prevention programs. According to the report, 86% of reported AIDS cases in the country were transmitted through sexual contact, PTI/Financial Express reports (PTI/Financial Express, 4/26).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Alcohol Use Rate Among American Indian Or Alaska Native Adults Is Well Below The National Average

A new national study reveals that the rate of past month alcohol use (i.e., at least one drink in the past 30 days) among American Indian or Alaska Native adults is significantly lower than the national average for adults (43.9 percent versus 55.2 percent). The study, sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) also shows that American Indian or Native Alaska adults have a rate of past month binge alcohol drinking (i.e., five or more drinks on the same occasion - on at least one day in the past 30 days) well above the national average (30.6 percent versus 24.5 percent). The level of past month illicit drug use was also found to be higher among American Indian or Alaska Native adults than the overall adult population (11.2 versus 7.9 percent).


Among the study's other significant findings:


- Eighteen percent of American Indian or Alaska Native adults needed treatment for an alcohol or illicit drug use problem in the past year, nearly twice the national average (9.6 percent).


- 1 in 8 (12.6 percent) American Indian or Alaska Native adults who were in need of alcohol or illicit drug treatment in the past year received it at a specialty facility - about the same as the national average (10.4 percent).


- American Indian or Alaska Native adults' past month substance use rates drop significantly in older age groups - for example, illicit drug use levels drop from 25.4 percent in the 18 to 25 age group to 4.1 percent in those 50 and older. This pattern is also seen in the general adult population.


The study was developed as part of the agency's strategic initiative on data, outcomes, and quality - an effort to create an integrated data strategy that informs policy makers and service providers on the nature and scope of behavioral health issues. It is one in a series of studies designed to provide more detailed information on substance abuse patterns and treatment needs existing within a wide range of population groups.


"Patterns of substance abuse vary somewhat among different segments of our society," said SAMHSA Administrator, Pamela S. Hyde, J.D. "Prevention, treatment and recovery support services are vitally needed within every community. We are using these studies along with on the ground experience to design and provide these services in a way that is accepted by the community and appropriate for individual needs."


"We appreciate SAMHSA's support of this study, which provides valuable findings that can be used for more targeted treatment programs and patient screening," said Dr. Yvette Roubideaux, the Director of the Indian Health Service.


Source:

Substance Abuse and Mental Health Administration (SAMHSA)

Personality traits and craving among pathological gamblers and alcoholics

There are two types of addiction-related craving: one is physical, which is related to withdrawal; and the other is memory-based, consisting of a desire that persists long after withdrawal has been subdued. A study in the August issue of Alcoholism: Clinical & Experimental Research compares craving between pathological gamblers and alcoholics, correlating craving with personality. Results indicate that gamblers and alcoholics have distinctive personality traits that affect their cravings.


"Personality, and temperament in particular, is defined as the usual basic emotional reactions and preferences towards both external and internal stimuli," said Hermano Tavares, coordinator of the Impulse Control Disorder Unit at the University of S?o Paulo in Brazil, and corresponding author for the study. "Craving is also defined in terms of the desire to use a drug and previous memories of pleasure superimposed upon a negative emotional state. So, both concepts involve emotional regulation and motivation. The idea of our study was to investigate if specific personality traits could influence the craving experience among alcoholics and pathological gamblers, making it stronger, hence rendering more vulnerability to addiction."


Study subjects (49 pathological gamblers, 101 alcoholics) were recruited from individuals seeking outpatient treatment at community agencies and a hospital-based treatment center in Calgary, Alberta between April 2001 and November 2002, as well as through local advertising. All participants were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders IV criteria, rated their cravings (for either alcohol or gambling), answered a semi-structured interview, and completed the Temperament and Character Inventory and Beck Scales for anxiety and depression.


"Both alcohol and gambling craving were directly related to clinical symptoms of depression and anxiety, and inversely related to length of abstinence," said Tavares. "However, alcohol and gambling cravings did not share temperament roots, pointing to different roles of both on emotional regulation. In other words, our study suggests that people turn to either alcohol or gambling for different reasons."


Tavares said that positive emotions and negative emotions are two separate, distinct and independent dimensions, possibly regulated by different brain systems. "We found that alcohol craving was based on the temperament factor responsible for negative emotions," he said. "This suggests that those individuals who are especially vulnerable to negative emotions are the ones who will miss alcohol the most when trying to abstain. Conversely, gambling craving correlated to the temperament factor responsible for positive emotions. This suggests that those individuals who naturally lack positive emotions and require intense stimuli to experience elation are the ones who will miss gambling the most when trying to abstain."















"Thus, gambling seems to be more of a stimulant and anti-depression measure," added Sheila Blume, former medical director of Addiction Programs at South Oaks Hospital in Amityville, New York. "For alcoholics, craving correlated more with anxiety and harm avoidance, which indicates that alcohol is more of an anti-anxiety measure. Of course, these are not exclusive. Alcoholics also drink and crave alcohol while depressed, and gamblers may crave when anxious, but these are statistical differences that can be helpful in understanding patients and in treatment planning."


Both Tavares and Blume dismissed the lay notions of "unhappiness" or "sadness" as factors in addiction.


"Unhappiness is too vague a concept," said Tavares. "Clinically speaking, anxiety is regarded as a state of negative emotionality and heightened arousal, while depression is best described as high negative emotions and low positive emotions. Heightened arousal and low positive emotions respectively differentiate anxiety from depression, and negative emotions are shared by both. Alcohol seems to provide a lessening of negative emotions and may be used as a 'tool' to deal with tensions and nervousness, that is, anxiety. Gambling seems to act as a 'fix' for individuals who are by nature partially deprived of feelings such as joy and elation, and require stronger stimuli to achieve emotional equilibrium and counterbalance depression."


"These findings are not dissimilar to the findings of others in the field with clinical populations," said Blume. "This is not the same as saying that all addicts have the same 'addictive personality' but there are some traits that tend to show up in alcoholics, drug addicts and pathological gamblers more strongly than in the general population. What is novel about this study is their correlation of these traits as well as emotional states with craving. To my knowledge, this has not been done before with alcoholics and pathological gamblers."


Tavares added that "it is important to say that not all individuals with similar personality profiles will develop alcohol or gambling problems, but they may be at greater risk if the environment does not provide the opportunity to learn how to adjust their nature. Being impulsive, prone to negative emotions, or requiring greater stimulation to attain joy may require special attention as these people could be at risk for a wider variety of addictive behaviors. Perhaps a combination of traits, rather than the identification of an isolated one, is a better strategy to re-start investigating the validity of the 'addictive personality structure,'" he said.


Blume suggested that future research look at the neurological basis of craving, as well as the mechanisms of how it works on a basic level. "We need better physiological measurements of craving and better anti-craving strategies," she said.


Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "A Comparison of Craving Between Pathological Gamblers and Alcoholics," were: Monica L. Zilberman of the Department of Psychiatry at the University of S?o Paulo; David C. Hodgins of the Department of Psychology at the University of Calgary; and Nady el-Guebaly of the Department of Psychiatry at the University of Calgary. The study was funded by the Brazilian National Council on Research and Development, and the Alberta Gaming Research Institute.


Hermano Tavares, M.D., Ph.D.

hermanotuol.br

55-11-3814-3920 (Brazil)

University of S?o Paulo

uol.br


Add'l contact: Sheila Blume, M.D.

sheila_blumepost.harvard


Alcoholism: Clinical & Experimental Research

alcoholism-cer

Problem Drug Use Declining In Previous Hot Spots, UK

Research led by the National Drug Evidence Centre at The University of Manchester has found that drug misuse seems to have passed its peak in some previous problem areas.



Mr Tim Millar and colleagues investigated the reality of the situation in perceived drug trouble-spots by estimating trends in the incidence1 of heroin use (i.e. changes in the number of people starting to use heroin). These indicated geographical differences in the progress of heroin ???epidemics??™, and suggested that problem drug use (PDU) is declining in some areas considered hot spots in the 1980s.



The study, undertaken with the Centre for Drug Misuse Research at the University of Glasgow and funded by the Home Office Drugs & Alcohol Research Unit, looked at data on almost 15 000 problem drug users using heroin who sought treatment in Greater Manchester between 1986 and 2000.



It used a new approach which takes account of the time-lag between people starting to use heroin and their coming forward to seek help, and focused on the City of Manchester, Stockport and Wigan. These areas exhibited the clearest patterns in the age-specific prevalence2 estimates produced using the traditional approach as part of the same study.



Mr Millar said: "Problem drug-use prevalence estimates for Wigan progressively declined with age, suggesting a younger PDU population than the other areas. This meant young people must have recently been recruited into the PDU population at a faster rate than previously, suggesting that problem drug use incidence would have recently increased in the area.



"The incidence-rate estimates we produced using the new method supported this, increasing for heroin use during the 1990s.



"By contrast, prevalence estimates for the City of Manchester indicated an older problem drug use population (mainly 25-34 years), prompting us to think that incidence might be in decline - with the rate at which young people are recruited into the PDU population waning and those recruited during an earlier epidemic phase ageing. Our incidence-rate estimates corroborated this, indicating a decrease during the 1990s.



"In Stockport, the prevalence estimates showed less difference between age-groups, suggesting incidence had remained stable, and this was backed-up by our incidence-rate estimates.



"Our theory that the areas would exhibit different patterns of recent incidence trends - with some places having ???passed their peak??™ whilst rates of use continue to rise in others - was borne out using this new approach, which has proven capable of providing valuable indications which may help us to forecast future developments.



"For example it might be expected that PDU prevalence in Wigan will increase but that the rate of growth slow, and older users start to account for a larger proportion.



"PDU prevalence in the City of Manchester could decline because of current cessation rates amongst those that joined the population during the 1980s when incidence was at its peak. Movement of existing problem drug users from suburban and rural areas to urban areas could also explain the apparent decline in incidence rates, although this would not be consistent with accepted theories about how problem drug use spreads outwards from urban centres.
















"Of course, Manchester and other 1980s hot spots continue to experience high levels of problem drug use, but it appears that situation could have stopped getting worse and may be starting to get better."






???Incidence??™ is the number of new cases of heroin use that emerge in the population
2 ???Prevalence??™ is the number of cases in the population at any given time
The University of Manchester (manchester.ac/) is the largest single-site higher education institution in the country, with 24 academic schools, over 5200 academic and research staff and around 36 000 students. It was awarded University of the Year by the Times Higher Educational Supplement in 2005 and The Sunday Times in 2006, and receives more undergraduate applications than any other UK university.



Its Faculty of Medical & Human Sciences (mhs.manchester.ac/) is one of the largest faculties of clinical and health sciences in Europe, with a research income of around ??51 million (almost a third of the University??™s total research income). The School of Medicine (medicine.manchester.ac/) is the largest of its five Schools, encompasses five teaching hospitals and is closely linked to general hospitals and community practices across the North West of England.



The National Drug Evidence Centre (NDEC) carries out epidemiological, evaluative and policy-related research in the field of drug misuse, working particularly with the Health Service and Criminal Justice Service at local, national and European levels. It is funded by the UK National Treatment Agency for Substance Misuse and has strong collaborative links with Imperial College London, the University of Glasgow and the Institut f??r Therapieforschung, Munich, as well as working closely with the Department of Health, Home Office and European Monitoring Centre on Drugs and Drug Addiction.



Contact: Jo Nightingale


University of Manchester

Compulsive Eating That Leads To Obesity Has Similar Biology To Drug Addiction

US researchers working with rats have shown for the first time that the compulsion to overeat that leads to obesity has the same biological
mechanism as seen in addiction to drugs like cocaine and heroin abuse: it affects the brain's pleasure circuitry in a similar way.


You can read about the study, conducted by Scripps Research Associate Professor Paul J Kenny and graduate student Paul M Johnson from The
Scripps Research Institute in Jupiter, Florida, in the 28 March advanced online issue of Nature Neuroscience.


According to a press statement from The Scripps Research Institute on Sunday, the study appears to confirm what many obesity patients have been
saying for years: like drug addiction, binging on junk food is very hard to stop.


Kenny and Johnson show that as pleasure centers in the brain become less responsive, rats quickly develop compulsive overeating habits, eating
increasing amounts of high-calorie, high-fat foods until they become obese.


This is the same progressively deteriorating chemical balance in reward brain circuits seen in rats that overconsume cocaine or heroin that is thought to
lie behind the development of compulsive drug use.


Kenny told the press that the study confirms that junk food can become "addictive". It explains what happens in the brains of the animals when they
can easily get hold of high-calorie, high-fat food, he said.


"It presents the most thorough and compelling evidence that drug addiction and obesity are based on the same underlying neurobiological
mechanisms," added Kenny, explaining that:


"In the study, the animals completely lost control over their eating behavior, the primary hallmark of addiction."


One of the tests of addictive behaviour is to train lab animals to anticipate an electric shock. At first the animals receive the mild shocks at the same
time as a light coming on, eventually they learn to anticipate the shock when they see the light and they avoid doing the thing that then triggers the
shock.


In this case, the rats that had become "addicted" to junk food ignored the light and continued to binge, highlighting how motivated they were, said
Kenny.


For the junk food they used in the study, Kenny and Johnson bought foods people love to eat: cheesecake, bacon, sausage, Ding-Dongs (a flat-shaped
chocolate cake popular in the US).


"The stuff that you enjoy, but you really shouldn't eat too often," Kenny said, as reported by Reuters.


They also bought healthy foods and put the rats into three groups: (1) a balanced healthy diet group, (2) a healthy diet group with access to high-calorie
"junk" food for one hour a day, and (3) a group that was fed healthy food but also had unlimited access to the high-calorie "junk" food.


Kenny said the third group quickly showed a preference for the junk food, ate it all day long and quickly became obese.















"They always went for the worst types of food," said Kenny.


"As a result, they took in twice the calories as the control rats," he added, explaining that when they removed the junk food and tried to feed them a
healthy diet, "the salad bar option", they just refused to eat.


"The change in their diet preference was so great that they basically starved themselves for two weeks after they were cut off from junk food," said
Kenny.


"It was the animals that showed the "crash" in brain reward circuitries that had the most profound shift in food preference to the palatable, unhealthy
diet. These same rats were also those that kept on eating even when they anticipated being shocked," he added.


What happens in addiction is "lethally simple", said Kenny, "the body adapts remarkably well to change -- and that's the problem".


"When the animal overstimulates its brain pleasure centers with highly palatable food, the systems adapt by decreasing their activity. However, now the
animal requires constant stimulation from palatable food to avoid entering a persistent state of negative reward," he explained.


After this first stage, where they showed the obese rats had developed clear addiction-like food seeking behavior, Kenny and Johnson then examined
the underlying biological mechanisms that might explain the change.


They were particularly interested in the dopamine D2 receptor in the brain, a receptor that is already known to play a role in vulnerability to drug
addiction and obesity. The receptor responds to dopamine, a chemical that the brain releases in response to pleasurable experiences like food, drugs
and sex.


For example, in cocaine abuse, the drug blocks the retrieval of dopamine, causing it to flood the brain and overstimulate the receptors. Eventually this
leads to physical changes in the brain and how it responds to the drug.


Kenny and Johnson have shown this to be the same in addiction to junk food.


Kenny said their findings confirm what they and many others had long suspected:


"Overconsumption of highly pleasurable food triggers addiction-like neuroadaptive responses in brain reward circuitries, driving the development of
compulsive eating." he said.


They also found that the levels of the D2 dopamine receptors were significantly lower in the brains of the obese animals, similar to what has been
reported in human drug addicts.


And when they used a specialized virus to knock down the receptor ("lentivirus-mediated knockdown") the addiction-like eating accelerated
dramatically.


The addiction-like eating started almost as soon as they knocked down the receptors, said Kenny.


"The very next day after we provided access to the palatable food, their brains changed into a state that was consistent with an animal that had been
overeating for several weeks," he added.


Kenny and Johnson concluded that:


"These data demonstrate that overconsumption of palatable food triggers addiction-like neuroadaptive responses in brain reward circuits and drives the
development of compulsive eating. Common hedonic mechanisms may therefore underlie obesity and drug addiction."


Grants from the Bank of America Fellowship, The Margaret Q. Landenberger Research Foundation and the National Institutes of Health paid for the
study.


"Dopamine D2 receptors in addiction-like reward dysfunction and compulsive eating in obese rats."

Paul M Johnson and Paul J Kenny.

Nature Neuroscience, Published online 28 March 2010.

DOI:10.1038/nn.2519


Sources: Scripps Research Institute, Reuters.



, PhD

Ignoring Scientific Advice About Illegal Drugs In Favour Of Politically And Morally Motivated Judgements Wont Send The Right Signal To Young People

An Editorial in this week's Lancet discusses the decision of the UK home secretary Jacqui Smith to ignore expert advice to downgrade ecstasy. The recent report by the Advisory Council on the Misuse of Drugs concluded "that the harmfulness of MDMA to individuals and society more closely equates to drugs in class B and it should therefore be downgraded."


The Editorial concludes: "Why then did the Home Office veto this recommendation? Apparently, because it did not want to send a signal to young people that MDMA was being taken less seriously. Last year, the Home Secretary also overruled the ACMD's recommendation that cannabis should remain a class C drug rather than gain class B status. These ill-thought out decisions make a mockery of the ACMD and any attempt at a credible, evidence-based system for drug classification. Ignoring scientific advice about illegal drugs in favour of politically and morally motivated judgments will not send the right signal to young people. It will only undermine public health messages about all drugs, be it MDMA or more harmful legal substances such as tobacco and alcohol."


The Lancet

Mental Illness And Drug Addiction May Co-occur Due To Disturbance In Part Of The Brain

Why do mental illness and drug addiction so often go together? New research reveals that this type of dual diagnosis may stem from a common cause: developmental changes in the amygdala, a walnut-shaped part of the brain linked to fear, anxiety and other emotions. A full report on why these "comorbid" disorders may develop appears in the December Behavioral Neuroscience, published by the American Psychological Association (APA).



Dual diagnosis is common yet difficult to treat. Addiction of all types - to nicotine, alcohol and drugs - is often found in people with a wide variety of mental illnesses, including anxiety disorders, unipolar and bipolar depression, schizophrenia, and borderline and other personality disorders. Lead author Andrew Chambers, MD, cites clinical reports that at least half the people who seek help with addiction or mental-health treatment have co-occurring disorders. Epidemiological data says that from two to five of every 10 anxious or depressed people, and from four to eight of every 10 people with schizophrenia, bipolar disorder, or antisocial personality, also have some type of addiction.



To find the scientific basis for this complex, seemingly intractable pairing, which has in the past been attributed to "self-medication," Chambers' team at the Indiana University medical school compared the adult mood- and drug-related behavior of two groups of adult rats: those whose amygdalas were surgically damaged in infancy and those whose amygdalas were left intact but who underwent a sham surgery, to equalize their treatment.



Rats with damaged (lesioned) amygdalas grew up abnormally under-responsive to ambiguous or potentially threatening stimuli. Not showing the normal caution, they moved significantly more in response to novelty, showed significantly less fear in an elevated maze, and kept socializing even when exposed to the scent of a predator.



Crucially, these same rats also were significantly more sensitive to cocaine after just one exposure. And rats given repeated cocaine injections later showed even stronger expressions of the enduring changes in behavior - suggesting an overall hypersensitivity to the addictive process.



Given that the experimental and control rats were raised in the same tightly controlled conditions, the only difference being their brain status, researchers concluded that the integrity of the amygdala was the root cause of both impaired fear behavior and heightened drug response.
















"Brain conditions may alter addiction vulnerability independently of drug history," says Chambers. He and his colleagues concluded that someone's greater vulnerability to addiction, rather than a given drug's ability to alter the symptoms of mental illness for better or worse (usually worse), more fully explains the high rates of dual diagnosis.



For these reasons, and given the lab evidence and the fact that dual diagnosis patients do less well on psychiatric medication than other patients, Chambers wondered whether the underlying problems in the brain - what he calls "neural inflexibility" - make it harder for these people to respond.



To improve the effectiveness of treatments for dual diagnosis, Chambers would like to see educators, counselors, physicians, and scientific researchers integrate insights into both mental health and addiction. Funding the simultaneous treatment of both disorders would also help, he observes, given that "dual-diagnosis cases are the mainstream among these patients, probably because addiction and mental illness are strongly linked by neurobiology."



What may harm the amygdala early in human development" Dr. Chambers cites the relatively rare cases of temporal lobe epilepsy, tumors or early brain injury. Far more common, he speculates, are complex interactions among subtle genetic and environmental factors that change the way the amygdala functions or is connected to the rest of the brain during childhood and adolescence. For example, he says, "Early emotional trauma, paired with a certain genetic background, may alter the early development of neural networks intrinsic to the amygdala, resulting in a cascade of brain effects and functional changes that present in adulthood as a dual-diagnosis disorder."







Article: "Neonatal Amygdala Lesions: Co-Occurring Impact on Social/Fear-Related Behavior and Cocaine Sensitization in Adult Rats," R. Andrew Chambers, MD, Tammy J. Sajdyk, PhD, Susan K. Conroy, BS Joan E. Lafuze, PhD, Stephanie D. Fitz, BS, and Anantha Shekhar, MD, PhD; Laboratory for Translational Neuroscience of Dual Diagnosis and Development, Institute of Psychiatric Research, Department of Psychiatry, Indiana University School of Medicine; Behavioral Neuroscience, Vol 121, No. 6.



The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 148,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting human welfare.



Source:

Pam Willenz

American Psychological Association