WHAT DRIVES AN ADDICT?

Source: UC Berkeley

What drives addicts to repeatedly choose drugs, alcohol, cigarettes, overeating, gambling or kleptomania, despite the risks involved?

Neuroscientists at the University of California, Berkeley, have pinpointed the exact locations in the brain where calculations are made that can result in addictive and compulsive behavior.

UC Berkeley researchers have found how neural activity in the brain's orbitofrontal and anterior cingulate cortex regulates our choices. These astonishing new findings could pave the way for more targeted treatments for everything from drug and alcohol abuse to obsessive-compulsive disorders.

'The better we understand our decision-making brain circuitry, the better we can target treatment, whether it's pharmaceutical, behavioral or deep brain stimulation," said Jonathan Wallis, associate professor of psychology and neuroscience at UC Berkeley and the principal investigator of the study published in the Oct. 30 online issue of the journal Nature Neuroscience.

Wallis was inspired to look into the brain mechanism behind substance abuse when he observed the lengths to which addicts will go to fulfill their cravings, despite the downside of their habit: He asked, "What has the drug done to their brains that makes it so difficult for them not to make that choice? What is preventing them from making the healthier choice?"

In the new study, he and fellow researchers targeted the orbitofrontal cortex and anterior cingulate cortex - two areas in the frontal brain - because previous research has shown that patients with damage to these areas of the brain are impaired in the choices they make. While these individuals may appear perfectly normal on the surface, they routinely make decisions that create chaos in their lives. A similar dynamic has been observed in chronic drug addicts, alcoholics and people with obsessive-compulsive tendencies.

"They get divorced, quit their jobs, lose their friends and lose all their money," Wallis said. "All the decisions they make are bad ones."

To test their hypothesis that these areas of the brain were the key players in impaired decision making, the UC Berkeley researchers measured the neural activity of macaque monkeys as they played games in which they identified the pictures most likely to deliver juice through a spout into their mouths.

The animals quickly learned which pictures would most frequently deliver the greatest amount of juice, enabling researchers to see what calculations they were making, and in which part of the brain. The brains of macaques function similarly to those of humans in basic decision making. The exercise was designed to see how the animals weigh costs, benefits and risks.

The results show that the orbitofrontal cortex regulates neural activity, depending on the value or "stakes" of a decision. This part of the brain enables you to switch easily between making important decisions, such as what school to attend or which job to take, and making trivial decisions such as coffee versus tea or burrito versus pizza. However, in the case of addicts and people with damage to the orbitofrontal cortex, the neural activity does not change based on the gravity of the decision, presenting trouble when these individuals try to get their brains in gear to make sound choices, the findings suggest.

As for the anterior cingulate cortex, the study found that when this part of the brain functions normally, we learn quickly whether a decision we made matched our expectations. If we eat food that makes us sick, we do not eat it again. But in people with a malfunctioning anterior cingulate cortex, these signals are missing, and so they continue to make poor choices, Wallis said.

PAIN KILLER DEATHS TRIPLE!

Source: Center for disease control and prevention

New numbers released show the number of Americans who died from overdoses of prescription painkillers more than tripled in the past decade, according to the Centers for Disease Control and Prevention. More people now die from painkillers than from heroin and cocaine combined. For every person who died of a prescription painkiller overdose in 1999, nearly four died in 2008. We are in the midst of an epidemic, says Grant Baldwin of the CDC in a recent interview. An estimated 14,800 people died in the United States from painkiller overdoses in 2008, a more than threefold jump from the 4,000 deaths recorded in 1999. The CDC said painkiller abuse and deaths are rising because the drugs are easier than ever to obtain. They cited the growth of “pill mills,” clinics that prescribe opioids without first conducting medical exams, and “doctor shopping,” or receiving multiple prescriptions from different doctors.
According to the CDC, enough painkillers were prescribed in 2010 to medicate every American adult around the clock for a month.

ADOLESCENTS AND AMPHETAMINES
Source: Science Daily
Amphetamine use in adolescence can cause neurobiological imbalances and increase risk-taking behavior, and these effects can persist into adulthood, even when subjects are drug free. These are the conclusions of a new study using animal models conducted by McGill University Health Centre (MUHC) researcher Dr. Gabriella Gobbi and her colleagues. The study, published in The International Journal of Neuropsychopharmacology, is one of the first to shed light on how long-term amphetamine use in adolescence affects brain chemistry and behavior. Amphetamine is a psychostimulant drug which produces increased wakefulness and focus, in association with decreased fatigue and appetite. This drug, commonly known as "speed," is also used recreationally and as a performance enhancer. According to the United Nations Office on Drugs and Crime (UNODOC) report (2011), more than 10 per cent of adolescents in the U.S. have used amphetamines. In Europe, between two and seven per cent of adolescents have tried amphetamines, and in Canada the number is estimated at just over five per cent.
Study subjects were given one of three dosing regimens of amphetamine during adolescence. When they reached adulthood, drugs were withdrawn and their neurophysiological activity and risk-taking behaviour were studied. "We focused on the key neurotransmitters serotonin, dopamine and norepinephrine," Dr. Gobbi explains. "We found abnormalities in brain activity associated with all three of these neurochemicals, called "monoamines." Imbalances of monoamines are associated with emotional disturbances and mental diseases such as depression or addiction."
Researchers also noted behavioral changes in all dosing groups. Hyperactivity was observed in rodents exposed to a moderate dose of amphetamine during adolescence, while risk-taking behavior increased in every dosage group.
"Obviously we have to be very cautious about applying these results to a human population," says Dr. Gobbi. "However, given the basic similarities between human and rodent brains, these results are cause for concern. They suggest that the effects of amphetamine use can persist into adulthood, even if the subject is no longer taking drugs, and that these effects include a tendency toward risk-taking behavior."

NICOTINE-THE GATEWAY DRUG

Source: NIDA

A landmark study in mice identifies a biological mechanism that could help explain how tobacco products could act as gateway drugs, increasing a person's future likelihood of abusing cocaine and perhaps other drugs as well, according to the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health. The study is the first to show that nicotine might prime the brain to enhance the behavioral effects of cocaine. The gateway drug model is based upon epidemiological evidence that most illicit drug users report use of tobacco products or alcohol prior to illicit drug use. This model has generated significant controversy over the years, mostly relating to whether prior drug exposure (to nicotine, alcohol or marijuana) is causally related to later drug use. Before now, studies have not been able to show a biological mechanism by which nicotine exposure could increase vulnerability to illicit drug use.
In the current study, by researchers at Columbia University, New York City, and published in Science Translational Medicine, mice exposed to nicotine in their drinking water for at least seven days showed an increased response to cocaine. This priming effect depended on a previously unrecognized effect of nicotine on gene expression, in which nicotine changes the structure of the tightly packaged DNA molecule, reprograms the expression pattern of specific genes, in particular the FosB gene that has been related to addiction, and ultimately alters the behavioral response to cocaine.
To examine whether the results from this study paralleled findings in humans, the researchers reexamined statistics from the 2003 National Epidemiological Study of Alcohol Related Consequences to explore the relationship between onset of nicotine use and degree of cocaine dependence. They found that the rate of cocaine dependence was higher among cocaine users who smoked prior to starting cocaine compared to those who tried cocaine prior to smoking.
These findings in mice suggest that if nicotine has similar effects in humans, effective smoking prevention efforts would not only prevent the negative health consequences associated with smoking but could also decrease the risk of progression and addiction to cocaine and possibly other illicit drug use. In the meantime, this mouse model provides a new mechanism to study the gateway theory from a biological perspective.

1 IN 4 AMERICANS BINGE DRINKING!

Source: National Survey on Drug Use and Health

Almost one-quarter of Americans age 12 or older say they participated in binge drinking in the previous month, according to a government survey. The National Survey on Drug Use and Health found binge drinking rates varied among states, ranging from 14.1 percent in Utah, to 29.8 percent in North Dakota. The survey defines binge drinking as having five or more drinks on one occasion.
The survey also found 8.4 percent of Americans have used an illegal drug in the previous month, USA Today reports. The survey, released by the Substance Abuse and Mental Health Services Administration (SAMHSA), found that 9.7 percent of teens ages 12 to 17 had used illegal drugs in the past month. In the past year, 10.8 percent of Americans reported using marijuana, and 6.4 percent used the drug in the previous month.
The survey included interviews with more than 137,000 people between 2008 and 2009.
Alaska had the highest rate of illegal drug use (13.5 percent), while Iowa had the lowest rate (5.3 percent). Kentucky had the largest percentage of smokers (32 percent); Utah had the smallest (16.4 percent). Oklahoma had the highest rate of people using pain relievers for non-medical reasons in the past year (8.1 percent); Iowa and Nebraska had the lowest rate (3.6 percent).
“No state is free from the unique impact of mental and substance use disorders,” SAMHSA Administrator Pamela S. Hyde, J.D., said in a news release. “Data like these give states the information they can use to target their prevention and treatment activities for the greatest benefit to their residents.”

CHANTIX-
NEW RESEARCH ABOUT NICOTINE REPLACEMENT THERAPY

Source: PLoS ONE

The poor safety profile of the smoking-cessation drug varenicline (Chantix™) makes it unsuitable for first-line use, according to a recent study. Varenicline, which already carries a "black box warning" from the U.S. Food and Drug Administration (FDA), showed a substantially increased risk of reported depression or suicidal behavior compared to other smoking-cessation treatments, according to researchers at Wake Forest Baptist Medical Center, the Institute for Safe Medication Practices, Harvard Medical School and Johns Hopkins University School of Medicine.
The researchers found that 90 percent of all reported suicides related to smoking- cessation drugs since 1998 implicated varenicline, even though it was on the market only four years in the nearly 13-year study period. They also found that varenicline was eight times more likely to result in a reported case of suicidal behavior or depression than nicotine replacement products.
"Our study contradicts the implications of a recent review by the FDA showing no difference in psychiatric hospitalizations between varenicline and nicotine replacement patches," said Curt D. Furberg, M.D., Ph.D., professor of Public Health Sciences at Wake Forest Baptist, co-author of the study and a nationally recognized leader in drug safety research. "The FDA hospitalization studies were flawed because they could not capture most of the serious psychiatric side effects, including suicide, depression, aggression and assaults. These can be catastrophic events but do not normally result in hospitalization.
"We found that Chantix is associated with more suicidal behavior reports than any other smoking-cessation drug on the U.S. market. The risks simply outweigh the benefits."

$600 MILLION SPENT ON TOBACCO

Source: FDA
The U.S. Food and Drug Administration (FDA) will spend about $600 million over five years on a campaign to educate the public about the dangers of tobacco. The first part of the campaign will target groups including youth, minorities, the military, the gay community and people with disabilities, Dr. Lawrence Deyton, Director of the FDA’s Center for Tobacco Products stated in a recent interview. The campaign will include ads on TV and in print, and will use social media including Facebook, Twitter and YouTube.
Deyton said the FDA hopes to reduce the smoking rate in the United States, which has been stalled at about 20 percent since 2004. “One of the big lessons that I’ve learned is that we might have great public health programs, but they will fail if we do not adequately educate the public about them,” he said.
The campaign will be paid for through fees the FDA is charging tobacco companies. Fees are collected based on each company’s share of the U.S. tobacco market. They were imposed as part of the 2009 Family Smoking Prevention and Tobacco Control Act, which gives the FDA authority to regulate the content, marketing and sale of tobacco products. The FDA hopes the first campaign will appear at the same time as the new warning labels on cigarette packs in the fall of 2012. The labels will carry graphic images of the consequences of smoking, including diseased lungs and rotting teeth.

EFFECTIVE ADDICTION TREATMENT

Source: Medical News Today

Portuguese researchers have discovered that rats exposed before birth to glucocorticoids (GC) not only show several brain abnormalities similar to those found in addicts, but become themselves susceptible to addiction (the glucorticoids, which are stress hormones, were used to mimic pre-natal stress). But even more remarkable, Ana João Rodrigues, Nuno Sousa and colleagues were able to reverse all the abnormalities (including the addictive behavior) by giving the animals dopamine (a neurotransmitter/ brain chemical).

The study has several implications for a start it alerts for the dangers of high levels of stress during pregnancy, but - since GC are often prescribed as an anti-inflammatory or to help organ maturation during pregnancy - it also calls for an urgent investigation on the effects of this drug in pregnant women. But it is what we learn about addiction that is most interesting - the work not only unveils stress as a new susceptibility factor for the disease, but also a very simple treatment that, if translated into humans, could one day mean an effective treatment, and maybe even the prevention of human addiction.

Drug addiction was for a long time a character flaw, a moral problem. Now, instead, is accepted as the complex brain disease that is with the addict a patient in need of treatment. After all many people try drugs, but only a few become addicts

And it is in these few that lays the key to the disease and its treatment.

So what do we know about these patients and the disease? First although the psychological and social contexts in which the drug is taken are important, as much as 50% of the compulsion is in the individual's genetic makeup. We know that addiction is linked to the mesolimbic system - the brain area that evolved to provide feelings of pleasure to actions that increase our survival chances, such as eat, sex and social stimulation.

In fact, drugs activate the mesolimbic circuit too, only far stronger than any physiologic stimulus. This leads to the production of very high quantities of dopamine the brain chemical linked to pleasure creating the euphoria that brings users back. After while, though, the brain no longer can cope with the constant " high" and adapts by becoming desensitised to dopamine (produced by any type of stimulus) what leads users to consume more in order to "feel" again and trapping those more susceptible in addiction. And with the brain changes induced by drugs being apparently long-lasting - since both cravings and relapses don't disappear with time it is not easy to escape once trapped.

Adding another piece to the puzzle, recently the disease was also linked to stress during crucial developmental periods, such as feotal life. In fact, high levels of prenatal stress increase propensity to mental problems and now have been suggested also to substance abuse, with the effects being mediated by glucocorticoids (GC).

Rodrigues and Sousa's group have a long history of interest in stress and have seen before that rats from mothers injected with GC while pregnant (mimicking pre-natal stress) show changes in their mesolimbic area and in the dopamine response. So in the study now published, following these results and the addiction-stress link, the researchers investigated the responses to drugs in rats exposed to GC while in the uterus. These rats were found to have a susceptibility to addiction not present in control (non-exposed) rats.

When their mesolimbic system was examined they also showed several structural and molecular abnormalities, including less dopamine. The levels of their dopamine receptor Drd2, despite initially being very high, once they experimented drugs, went to abnormally low levels . So why is this important? Because reduced dopamine and Drd2 levels are typical of addicts suggesting that stress and long-term exposure to drugs affect the brain in very similar ways what could explain why the first could lead to the second.

The good news is that low levels of dopamine can be treated so Rodrigues and colleagues restored the rats' dopamine levels to normal just to find,much to their surprise, that all the structural and molecular abnormalities induced by prenatal GC were reversed. Even more surprising, the addictive behavior also disappeared.

As Ana João Rodrigues explains, "This is a remarkable result because it suggests that with a relatively simple pharmacological approach- restoration of dopamine levels- we can eventually treat, and even more importantly, potentially prevent drug abuse in vulnerable individuals. Of course that we still have a long way to go but our results are quite promising. In fact, if we know where susceptibility to substance abuse lies and low dopamine and altered Drd2 response seems to be it - then maybe we can find better ways to prevent/treat this disorder. "

Restoring dopamine levels has been used to treat cocaine cravings but the few trials looking at its effect on addiction were never very clear. One possible reason might be the length or the dosages used in Rodrigues' study, rats treated for 3 days reverted back to an addictive behavior 3 weeks after the end of the treatment, but this no longer occurs if the treatment continues for 3 weeks.

Drug abuse and addiction carry enormous social and financial costs to society, families and individuals. Only in the US, the National Institute for Drug Abuse calculates that more than 600 billion dollars are being spent, annually, to combat the disease.

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ATTENTION SMOKERS-
Source: Science Daily
Scientists now understand more about why being exposed to nicotine while you were a fetus will increase your risk of developing cardiovascular disease as an adult. "We have found distinct links between cigarette smoking or even using nicotine patches or gum and the long-term harm for the child," says Dr. DaLiao Xiao, a scientist who works at the Loma Linda University School of Medicine in California. Publishing their research in the British Journal of Pharmacology, Xiao and colleagues showed that when he gave nicotine to pregnant rats, the offspring had higher risks of high blood pressure than animals whose mothers didn't receive nicotine during pregnancy. While the work was carried out in rats, these findings fitted well with studies carried out in people.
Importantly, the researchers have discovered that specific changes in the blood vessel walls account for this outcome. The study shows that nicotine causes the formation of chemicals, known as reactive oxygen species (ROS), in the walls of blood vessels in the fetus. These ROS cause permanent changes that alter the normal behaviour of the blood vessel. This faulty programming is then carried throughout the individual's life and may lead to high blood pressure in adults.
"Other researchers have shown that cigarette smoking or nicotine use in pregnant women results in an increased risk of hypertension and cardiovascular disease in adulthood. Our findings provide novel information of the fetal programming that links fetal nicotine exposure to the long term damage," says Xiao.
In a commentary accompanying the paper, Rebecca Lim, of The Ritchie Centre, Monash Institute of Medical Researc, and Associate Professor Christopher Sobey, of the Department of Pharmacology, Monash University, Australia, state: "If this is ultimately proven in humans, this important work will have revealed a novel cardiovascular risk factor that can only be modified before birth."

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CAREFUL WITH YOUR SCRIPTS-
SOURCE: DREXEL UNIVERSITY
A new study by researchers at Drexel University's School of Public Health suggests that abuse of prescription painkillers may be an important gateway to the use of injected drugs such as heroin, among people with a history of using both types of drugs. The study, published in the International Journal of Drug Policy, explores factors surrounding young injection drug users' initiation into the misuse of opioid drugs. Common factors identified in this group included a family history of drug misuse and receiving prescriptions for opioid drugs in the past. The results support a need for efforts to prevent misuse of prescription drugs, particularly during adolescence.
"Participants were commonly raised in household where misuse of prescription drugs, illegal drugs, or alcohol, was normalized," explains Dr. Stephen Lankenau, an associate professor in the School of Public Health and principal investigator of the study. "Access to prescription medications -- either from a participant's own source, a family member, or a friend -- was a key feature of initiation into prescription drug misuse."
In numerous cases, the desire to experiment with a prescription opioid drug (the common class of drugs that includes codeine and oxycodone), combined with financial incentives or pressures from friends to sell available quantities, resulted in escalated patterns of opioid misuse, according to the study.
Lankenau and colleagues also describe two key findings as evidence of an emerging dynamic among misuse of opioid drugs and the use of injection drugs. First, four of five IDUs misused an opioid before injecting heroin, in contrast to more conventional patterns of using opioids as a substitute drug after initiating heroin use.
Second, in nearly one out of four young IDUs in this study, a prescription opioid was the first type of drug they injected. Prescription opioids are rarely reported at initiation into injection drug use amongst young IDUs. All but two of these participants later transitioned into injecting heroin.
Opioid misuse is an important public health concern due to the increasing association of opioids with drug dependence and fatal overdose, and much research has focused on the factors affecting how and when people initially misuse opioids. However, descriptive data about initiation into prescription opioid misuse among young injection drug users are scarce.
To fill this gap, in this study researchers interviewed 50 young IDUs aged 16 and 25 years old in New York and Los Angeles, who had misused a prescription drug at least three times in the past three months, to study contextual factors leading to their use of opioid drugs. Participants were recruited in natural settings, such as parks, streets, and college campuses, during 2008 and 2009. A mixed-methods research design was utilized that collected both quantitative and qualitative data.
Additional findings and descriptors of the study population include:
Most were white, heterosexual males in their early 20s
Many did not complete high school, were expelled from school, or held back a grade
Nearly all were homeless at some point, most were currently homeless, and most regarded themselves as "travelers," (i.e., moving from city to city in search of work, housing, or adventure)
Most had received a psychological diagnosis, such as depression, anxiety, or Attention Deficit Hyperactivity Disorder (ADHD), and many had a history of drug treatment
Most generally regarded prescription opioids as readily accessible, valued commodities that could be traded or sold
Nearly three-quarters had been prescribed an opioid in their lifetime, which occurred on average at 14.6 years old, often for common ailments such as dental procedures or sports injuries
Most witnessed family members misuse one or more substances during childhood and adolescence, ranging from alcoholism to injecting heroin
The authors conclude that prevention efforts, especially during adolescence, are needed, and that parents and guardians need to carefully monitor and safeguard all prescription medications, particularly opioids, within the household. Although households where drug use is normalized or where broader social or psychological problems exist are more difficult to remedy with prevention efforts or policy changes, future research examining prescription opioid misuse among a range of adolescents and young adults to better understand the contextual and environmental factors of drug use may yield additional solutions.
The article was co-authored by Karol Silva (Drexel University); Michelle Teti (University of Missouri); Alex Harocopos (National Development and Research Institutes); and Jennifer Jackson Bloom and Meghan Treese (Children's Hospital Los Angeles).
Lankenau is also principal investigator of two studies evaluating the effectives of overdose prevention programs in Los Angeles and Philadelphia.
Lankenau is an associate professor in the Department of Community Health & Prevention at the Drexel University School of Public Health. He received his PhD and MA degrees in Sociology from the University of Maryland. He earned his BA in Sociology at the University of Vermont.

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DENTISTS OR DEALERS
Source: Journal of American Dental Association
The Obama administration turned a bright spotlight on prescription painkiller abuse in April when the Office of National Drug Control Policy released a national action plan and a statement from Vice President Joe Biden. With a cover article in the July edition of the Journal of the American Dental Association (JADA), dentists focus that spotlight on themselves both as major sources of opioid drugs and as professionals with largely untapped power to recognize and reduce abuse.
Many dentists really haven't even perceived there to be a problem," said George Kenna, an assistant professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University, an addiction psychologist at the Center for Alcohol and Addiction Studies, and the corresponding author of the article. "Dentists write the third-most prescriptions for immediate release opioids in the United States, but they often don't know the appropriate number of doses to prescribe, how many doses a patient uses, or most importantly what patients do with the leftover tablets they have. Just ask someone the last time they threw away opioid prescriptions in particular. These leftover tablets -- accumulated from various sources, not just dentists -- that are often left in closets across the country are the primary source for prescription drug use initiation for children and adolescents."
As outlined by the administration's policy, facilitating ways to reduce the number of leftover painkillers such as hydrocodone and oxycodone that can become a supply of drugs in the home for those who would abuse them, dentists and other prescribers would be taking a significant step, said Kenna who is also a pharmacist. The National Survey on Drug Use and Health has found that seven in 10 people who have used painkillers nonmedically got the drugs through a family member or friend who had a prescription.
Last year Kenna helped lead a meeting of dentists and fellow addiction experts and pharmacists at the Tufts Health Care Institute Program on Opioid Risk Management, where he serves as a scientific adviser. The group produced this month's cover article for JADA, which offered several recommendations for dentists, including:
Discuss with patients whether they need an opioid for their pain and how likely they are to use what you prescribe.
Consider writing small quantities and limit refills.
Do not prescribe drugs to patients you do not know; be suspicious of those who claim their drugs were lost or stolen.
Use prescription monitoring programs (i.e., state databases), if available, to verify drug-use history.
Advise patients either to destroy or lockup any excess medication.
Keep prescription pads locked up.
In the article, the nine authors also call for more research to make the most effective use of opioid and non-opioid painkillers, for instance to determine how much painkiller and which kind patients really need. Without enough evidence to guide them, dentists have often felt obliged to prescribe opioids too often and in too great a quantity, Kenna said.
"Some new data show that ibuprofen as an anti-inflammatory does as well as many painkillers to kill pain for many dental procedures," Kenna said.
Despite the large role dentists have as painkiller prescribers, there has been very little research on dentists' prescribing practices and experiences, particularly in the context of opioid addiction. To inform their discussion, the group commissioned a survey in 2010, led by Michael O'Neil, a pharmacy professor at the University of Charleston in West Virginia. In all, 52 percent of the state's dentists responded.
The survey revealed that nine in 10 of the dentists surveyed prescribed opioids in the prior year. Two-thirds prescribed between 10 and 20 doses of the painkillers, but 41 percent acknowledged that patients would probably have some left over.
The survey also found some evidence that dentists can sometimes be shy about raising substance abuse as an issue with patients, even as they realize they are sometimes being used to get drugs. One in three of the dentists said they did not routinely ask new patients about substance abuse, but 58 percent of the dentists said they believed they have been the victim of prescription fraud or theft.
While dentists should guard against over-prescribing addictive drugs, especially to patients they don't know well, Kenna said, they retain an obligation to help all patients, even ones who are addicted, to manage pain.
"There are ways that dentists can work with patients," he said. "People who have a substance abuse problem do have legitimate pain. They do have a right to have some pain control and may even need more. But you hope there is a family member who will take control and make sure they only take the recommended dose."
For all the things dentists could do, especially with more research to clarify the best prescribing practices, Kenna acknowledged that dentists are not currently compensated for the time required to investigate the drug use preferences and habits of their patients.
Kenna said he hopes to learn more about how the profession approaches opioids and addiction with a national survey of dentists.
"It's a growing problem in the United States," he said. "It's a serious problem."

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HOPE FOR COCAINE ADDICTION
Source: Medical News Today
New discoveries by researchers at the University of Wisconsin-Milwaukee (UWM) offer potential for development of a first-ever pharmacological treatment for cocaine addiction.
A common beta blocker, propranolol, currently used to treat people with hypertension and anxiety, has shown to be effective in preventing the brain from retrieving memories associated with cocaine use in animal-addiction models, according to Devin Mueller, UWM assistant professor of psychology and a co-author with James Otis of the research.
This is the first time that a therapeutic treatment has been shown to block the retrieval of memories associated with drug addiction, a major reason many addicts experience relapse, says Mueller.
The research is published in the August issue of the journal Neuropsychopharmacology ("Inhibition of ß-Adrenergic Receptors Induces a Persistent Deficit in Retrieval of a Cocaine-Associated Memory Providing Protection against Reinstatement.")
Cocaine is one of the worst drug addictions to kick, with about 80 percent of those trying to quit experiencing a relapse within six months.
"Right now, there are no FDA-approved medications that are known to successfully treat cocaine abuse," says Mueller, "only those that are used to treat the symptoms of cocaine withdrawal, which are largely ineffective at preventing relapse."
The effects of propranolol were long-lasting and could be permanent, he says, even without subsequent doses and even in the presence of stimuli known to induce relapse.
Currently, "exposure therapy" is used to help recovering addicts suppress their drug-seeking behavior. In this therapy, the patient is repeatedly exposed to stimuli that provoke cravings but do not satisfy them. Done repeatedly over time, the patient experiences less craving when presented with those stimuli.
The success of exposure therapy, however, is limited. Combining therapy with the use of propranolol, says Mueller, would boost the effectiveness of the treatment.
Propranolol was chosen for the memory study because it has been used before to ease some withdrawal symptoms experienced by recovering cocaine addicts. Those using the drug were able to continue exposure therapy for longer periods than those without the drug.
But Mueller adds that propranolol has never been tested for use with memory extinction before.
In order to develop a drug treatment for overcoming relapse, the next step in the research is to determine where in the brain propranolol acts to mediate the retrieval of cocaine-associated memories.

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ALMOST A QUARTER OF ALL AMERICANS BINGE DRINKING!
Source: National Survey on Drug Use and Health
Almost one-quarter of Americans age 12 or older say they participated in binge drinking in the previous month, according to a government survey. The National Survey on Drug Use and Health found binge drinking rates varied among states, ranging from 14.1 percent in Utah, to 29.8 percent in North Dakota. The survey defines binge drinking as having five or more drinks on one occasion.
The survey also found 8.4 percent of Americans have used an illegal drug in the previous month, USA Today reports. The survey, released by the Substance Abuse and Mental Health Services Administration (SAMHSA), found that 9.7 percent of teens ages 12 to 17 had used illegal drugs in the past month. In the past year, 10.8 percent of Americans reported using marijuana, and 6.4 percent used the drug in the previous month.
The survey included interviews with more than 137,000 people between 2008 and 2009.
Alaska had the highest rate of illegal drug use (13.5 percent), while Iowa had the lowest rate (5.3 percent). Kentucky had the largest percentage of smokers (32 percent); Utah had the smallest (16.4 percent). Oklahoma had the highest rate of people using pain relievers for non-medical reasons in the past year (8.1 percent); Iowa and Nebraska had the lowest rate (3.6 percent).
“No state is free from the unique impact of mental and substance use disorders,” SAMHSA Administrator Pamela S. Hyde, J.D., said in a news release. “Data like these give states the information they can use to target their prevention and treatment activities for the greatest benefit to their residents.”

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IV Drug Users
Source: Medical News Today
Botulism is a rare disease and recurrent botulism even more rare. However, in California, recurrent wound botulism among injection drug users has been on the rise and makes up three-quarters of reported cases in the United States. From 1993 through 2006, 17 injection drug users were identified within the surveillance system of the California Department of Public Health for having recurrent wound botulism. Clinical symptoms ranged from acute paralysis to slurred speech to difficulty swallowing, and at least one case of wound botulism for each patient was laboratory confirmed. Of those, 14 had one recurrence and three had two recurrent episodes. All of the patients reported heroin use, with 88 percent specifically reporting black tar heroin use.
"Recurrent cases suggest that exposure to botulism due to injection drug use does not result in protective immunity," according to study author Duc Vugia, MD, of the California Department of Public Health. "As a result, both clinicians and injection drug users should be aware of the potential for wound botulism to recur with continued injection drug use to allow for timely diagnosis and early administration of appropriate treatment."
Dr. Vugia added, "If these near death experiences do not change behavior among these injection drug users and if severe disease from exposure to botulism does not confer immunity, recurrent wound botulism will continue to occur and add to the health care burden. Continued efforts to reduce injection drug use and educate current users on the infectious risks associated with illicit drug use are crucial to improving the health of the injection drug use population."

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Link Between Victims and Substance Abuse
Source: University of IL. At Chicago

A strong link between victimization experiences and substance abuse has been discovered by researchers at the University of Illinois at Chicago. The correlation is especially prevalent among gays, lesbians and bisexuals -- more so than in heterosexuals, says Tonda Hughes, professor and interim head of health systems science in the UIC College of Nursing. Hughes is lead author of the study, published in the journal Addiction.
Researchers compared victimization experiences of unwanted sexual activity, neglect, physical violence, and assault with a weapon, across four sexual-identity subgroups -- heterosexual, gay or lesbian, bisexual, or "not sure." The study used data collected nationally from 34,635 adults from the National Epidemiologic Survey on Alcohol and Related Conditions.
Hughes and her research team wondered if sexual-minority women and men are at a heightened risk for victimization. The results, Hughes said, showed that they are.
Lesbian and bisexual women were more than twice as likely as heterosexual women to report any victimization over their lifetime. Lesbians, gay men and bisexual women also reported a greater number of victimization experiences than did heterosexuals. Three times as many lesbians as heterosexual women reported childhood sexual abuse.
One possible explanation for this disproportionality, Hughes said, is that lesbians are more willing to acknowledge and report this experience.
"Gays and lesbians tend to be more self-reflective," she said. "This means they are more likely to think about and report negative or stigmatizing life experiences. Heterosexuals may not be inclined to do so."
Gay men also had high rates of victimization, with about half of them reporting any lifetime victimization. They reported significantly higher rates of childhood sexual abuse, childhood neglect, partner violence and assault with a weapon than heterosexual men.
Not only are there higher rates of violence and victimization among sexual minorities, but there is also a higher rate of substance abuse, Hughes said.
Regardless of sexual identity, women who reported two or more victimization experiences had two to four times the prevalence of alcohol dependence, drug abuse or drug dependence as women who reported no victimization, she said.
The research also concluded that gay, lesbian and bisexual youth may use substances to cope with adverse psychological and interpersonal effects of victimization, increasing the risk for further victimization from others, she said.
The study was funded through grants from the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, two of the National Institutes of Health.

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Drug Use and Your Health
Source: Journal of Medical Microbiology
Illicit drug users are at increased risk of being exposed to microbial pathogens and are more susceptible to serious infections say physicians writing in the Journal of Medical Microbiology. The review, which aims to improve the microbiological diagnosis of drug use-related infections, assesses the role of drug related practices in the spread of a range of bacterial, viral, fungal and protozoal infections.
The review by collaborators from the Armed Forces Medical College, Pune, India highlights convincing evidence that unsterile injection practices, contaminated needles, syringes and the use of cutting agents all represent avenues by which micro-organisms can enter the body. Outbreaks of tetanus, Group A Streptococcal disease and, more recently, anthrax have all been documented in illicit drug users.
Drug abuse not only enhances exposure to pathogens but can also increase the risk of infection by facilitating the local growth of micro-organisms and suppressing the user's overall immunity. Dr Karishma Kaushik one of the authors, says, "Drugs such as cannabis and opiates have been shown to directly suppress immune function. Methadone has also been shown to enhance HIV replication in immune cells. What's more, dead or damaged tissue at an injection site provides an ideal anaerobic environment for certain pathogens to grow. The bacterial species Clostridia, for example, thrive in anaerobic environments and can lead to wound botulism, tetanus and necrotizing fasciitis - commonly known as the flesh-eating disease."
The association between drug use and the transmission of certain viral pathogens is well established. Illicit drug users represent the major risk group for acquiring hepatitis C infection and also bear a substantial burden of HIV infection globally. "Drug abuse accounts for at least 10% of HIV infections globally and this may rise to 40% in the near future," explains Dr Kaushik. "Drug use also contributes to the spread of HIV in non-drug user populations such as from injecting husbands to their non-injecting wives. Associated lifestyle practices such as multiple sexual partners are also co-factors in increasing the risk of infection," she says.
Dr Kaushik believes that an increased awareness of the microbial complications associated with drug use will allow better diagnosis and management of infections in this group. "Infections are one of the most serious complications of drug abuse. They are frequently encountered in the hospital setting and constitute a major burden to the health care system. Yet drug users are a relatively poorly studied cohort of patients seeking clinical care."

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Church, Clergy Helping Addicts
Source: Join Together/University of Michigan
About 15 percent of people seeking recovery from alcoholism turn to clergy members for support, a University of Michigan study finds. A survey of 1,910 individuals with alcohol-related problems found that while many people seek help from clergy, most do so in conjunction with professional services. Just 0.5 percent sought to recover through counseling with a priest or other clergy member alone."Clergy are in a unique position to notice changes in behavior over time," said study co-author Brian Perron. "Their roles as senior leaders of churches, their embodiment of important tenants of their faiths, and their formal roles as caregivers of their congregations also lend clergy considerable credibility, particularly within African-American communities. Clergy are often seen as being deeply committed to their congregants and willing to honor desires for confidentiality."

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Watch What You Say!
Source: Science Daily
Stereotyping has a lasting effect. Aggression. Over-eating. Inability to focus. Difficulty making rational decisions. New research out of the University of Toronto Scarborough shows prejudice has a lasting negative impact on those who experience it. "Past studies have shown that people perform poorly in situations where they feel they are being stereotyped," says Associate Professor of Psychology Michael Inzlicht, who led the study, published in this month's edition of the Journal of Personality and Social Psychology. "What we wanted to do was look at what happens afterwards. Are there lingering effects of prejudice? Does being stereotyped have an impact beyond the moment when stereotyping happens?"
In order to determine whether negative stereotyping in a particular situation had lasting effects, Inzlicht's team performed a series of tests. First, they placed participants in situations where they had to perform a task in the face of negative stereotyping. After the participants were removed from the prejudicial situation, researchers measured their ability to control their aggression, eat appropriate amounts, make rational decisions, and stay focused.
Their results show that prejudice and stereotyping have lingering adverse impacts.
"Even after a person leaves a situation where they faced negative stereotypes, the effects of coping with that situation remain," says Inzlicht. "People are more likely to be aggressive after they've faced prejudice in a given situation. They are more likely to exhibit a lack of self control. They have trouble making good, rational decisions. And they are more likely to over-indulge on unhealthy foods."
In one portion of the study, researchers had a group of women write a math test. They told the women this test would determine whether or not they were capable and smart in math, subtly injecting stereotypes about women and math skills "into the air," says Inzlicht. A separate group of women wrote the same test, except this group was given support and coping strategies to deal with the stress they'd face when writing the test.
After completing the math test, the two groups performed another series of tasks designed to gauge their aggression levels, their ability to focus and to exercise self control.
"In these follow-up tests, the women who felt discriminated against ate more than their peers in the control group. They showed more hostility than the control group. And they performed more poorly on tests that measured their cognitive skills," says Inzlicht.
The pattern remained the same, regardless of the test groups. People who felt they were discriminated against -- whether based on gender, age, race or religion -- all experienced significant impacts even after they were removed from the situation, says Inzlicht.
"These lingering effects hurt people in a very real way, leaving them at a disadvantage," says Inzlicht. "Even many steps removed from a prejudicial situation, people are carrying around this baggage that negatively impacts their lives."
Editorial: I have long felt the power of words, the words we choose can be crippling. As long as certain words remain acceptable we will only be able to go so far with a recovery movement. Challenge yourself to watch what you say, words hurt. When we place labels on people we are only recognizing and identifying one single part of a bigger whole. People in recovery themselves often do this as well identifying themselves by first name followed by the word addict or alcoholic. Interestingly enough I cannot recall my grandfather or anyone else for that matter ever referring to himself as Cancer yet it’s also a progressive, fatal disease if it goes untreated. Recovering people are so much more than what they are addicted to/recovering from, they are mothers, fathers, sisters, and our brothers so please reconsider your choice of words before you open your mouth when having dialogue with a person suffering with this disease called addiction. Furthermore when talking to anyone in general because you never know who you are talking to, it may be someone in need of help so don’t be an obstacle be the opportunity!

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Teens And Their Internet…Addiction, Depression?
Source: MSNBC.COM/Reuters

HONG KONG — Teenagers who spend excessive amounts of time on the Internet are one and a half times more likely to develop depression than moderate web users, a study in China has found. Researcher Lawrence Lam described some of the signs of excessive use spending at least five to more than 10 hours a day on the Web, agitation when the teens is not in front of the computer and loss of interest in social interaction."Some spend more than 10 hours a day, they are really problematic users and they show signs and symptoms of addictive behavior ... browsing the Internet, playing games," said Lam, co-author of the paper which was published on Tuesday in the Archives of Pediatrics & Adolescent Medicine."They can't get their minds off the Internet, they feel agitated if they don't get back on after a short period of being away," the psychologist at Sydney's University of Notre Dame's School of Medicine said in a telephone interview."They don't want to see friends, don't want to join family gatherings, don't want to spend time with parents or siblings."
The study involved 1,041 teenagers aged between 13 and 18 years in China's southern Guangzhou city who were free of depression at the start of the investigation.Nine months later, 84 of them were assessed as suffering from depression and those who were on the Internet excessively were one-and-a-half times more vulnerable than moderate users."Results suggested that young people who are initially free of mental health problems but use the Internet pathologically could develop depression as a consequence," wrote Lam, who co-authored the paper with Zi-wen Peng at the Sun Yat-Sen University's School of Public Health in Guangzhou.The depression might be a result of lack of sleep and stress from competitive online games, he explained."People who spend so much time on the Internet will lose sleep and it is a very well established fact that the less one sleeps, the higher the chances of depression," Lam said.Lam said this was the first study looking into pathological use of the Internet as a possible cause for depression.A previous study pointed to depression as a possible causal factor for Internet addiction, while several other studies showed a link between the two without clearly pointing which was the cause and which one the result.Lam called for schools to screen students for Internet addiction, so they may receive counseling and treatment.

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New Report Pinpoints Substance Abuse Across The Country
Source: Medical News Today/SAMHSA

A new report shows that behavioral health problems affect every community throughout America but in unique, and sometimes surprising ways. The report, based on a nationwide survey commissioned by the Substance Abuse and Mental Health Services Administration (SAMHSA), offers detailed analyses of the substance use problems occurring within these smaller geographical areas.
Since various regions of a state can experience significantly different types of behavioral health problems this type of information is helpful in targeting behavioral health services to where they are most needed. For example, in Ohio alcohol use disorders range from 6.4 percent in a region in the south central part of the state (Adams, Fayette, Gallia, Highland, Jackson, Lawrence, Meigs, Pickaway, Pike, Ross, and Scioto counties) to 9.5 percent in Franklin County.
"This report provides insight into the different behavioral health needs of communities across the nation," SAMHSA Administrator Pamela S. Hyde, J.D. said. "States and communities can use the data to inform and target the delivery of prevention and treatment services to meet their unique needs."
The report was developed as part of the agency's strategic initiative on prevention as well as 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.
Entitled, Substate Estimates from the 2006-2008 National Surveys on Drug Use and Health, the report measures and analyzes 21 substance use behaviors in 344 substate regions representing all 50 states and the District of Columbia. In most states, the substate regions are defined in terms of counties or groups of counties. In a few states, these areas are defined in terms of census tracts, parishes (in Louisiana), or boroughs/census areas (in Alaska).
The report's results were based on the combined data from the 2006 to 2008 National Surveys on Drug Use and Health (NSDUH) and involved responses from more than 200,000 people age 12 or older throughout the United States.

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The Power Of Perceptions
Source: Wake Forest University
So is the glass half empty or half full? Is it an obstacle or and opportunity for growth? Do you see things as problems or challenges? A new study has shed some light on how the power of perceptions in particular your own relates to your happiness.
"Your perceptions of others reveal so much about your own personality," says Dustin Wood, assistant professor of psychology at Wake Forest and lead author of the study, about his findings. By asking study participants to each rate positive and negative characteristics of just three people, the researchers were able to find out important information about the rater's well-being, mental health, social attitudes and how they were judged by others.
The study appears in the July issue of the Journal of Personality and Social Psychology. Peter Harms at the University of Nebraska and Simine Vazire of Washington University in St. Louis co-authored the study.
The researchers found a person's tendency to describe others in positive terms is an important indicator of the positivity of the person's own personality traits. They discovered particularly strong associations between positively judging others and how enthusiastic, happy, kind-hearted, courteous, emotionally stable and capable the person describes oneself and is described by others.
"Seeing others positively reveals our own positive traits," Wood says.
The study also found that how positively you see other people shows how satisfied you are with your own life, and how much you are liked by others.
In contrast, negative perceptions of others are linked to higher levels of narcissism and antisocial behavior. "A huge suite of negative personality traits are associated with viewing others negatively," Wood says. "The simple tendency to see people negatively indicates a greater likelihood of depression and various personality disorders." Given that negative perceptions of others may underlie several personality disorders, finding techniques to get people to see others more positively could promote the cessation of behavior patterns associated with several different personality disorders simultaneously, Wood says.
This research suggests that when you ask someone to rate the personality of a particular coworker or acquaintance, you may learn as much about the rater providing the personality description as the person they are describing. The level of negativity the rater uses in describing the other person may indeed indicate that the other person has negative characteristics, but may also be a tip off that the rater is unhappy, disagreeable, neurotic -- or has other negative personality traits.
Raters in the study consisted of friends rating one another, college freshmen rating others they knew in their dormitories, and fraternity and sorority members rating others in their organization. In all samples, participants rated real people and the positivity of their ratings were found to be associated with the participant's own characteristics.
By evaluating the raters and how they evaluated their peers again one year later, Wood found compelling evidence that how positively we tend to perceive others in our social environment is a highly stable trait that does not change substantially over time.

So again I ask you to challenge your thought process and remember conceive it, believe it, achieve it! You can do whatever you put your mind to!

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Meth Admissions Go Down Thanks To With Drug Control Efforts
Source: Medical News Today/Addiction Journal
A study published in the scientific journal Addiction shows that the Mexican government's recent efforts to control the manufacture of methamphetamine have caused a drop in methamphetamine treatment admissions in Mexico and in neighbouring Texas. In 2005 Mexico began controlling its imports of pseudoephedrine (a precursor chemical used in the manufacture of methamphetamine), and in 2008 it became the first country in North America to ban all imports of pseudoephedrine as well as ephedrine, another important precursor chemical. Researchers estimate that the 2005 import controls caused a 12% drop in voluntary methamphetamine treatment admissions in Mexico, with similar reductions in Texas. An even larger drop in voluntary admissions occurred following the 2007 closure of a commercial chemical company suspected of illicitly importing more than 60 tons of pseudoephedrine into Mexico. The head of the company fled Mexico but was eventually arrested in the United States. Methamphetamine treatment admissions in Mexico decreased by 56% following the closure of the company, with Texas showing similar results. All decreases in admissions appeared to be specific to methamphetamine, as researchers found no concurrent changes in cocaine, heroin, and alcohol treatment admissions during the same period. The study wound up shortly after the 2008 bans on precursor chemicals came into effect, so researchers weren't able to examine fully the impact of those bans; however, the researchers noted that treatment admissions in Mexico showed signs of declining in the first few months following the bans. Says lead researcher James Cunningham, a Fulbright Scholar at The University of Arizona: "These findings constitute the first evidence outside the United States that a country's precursor chemical controls can have positive public health results both domestically and internationally."

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