April 2013 Family Update

SUBSTANCE ABUSE Binge Drinking, Underage drinking

Physicians often fail to ask high school-aged patients about alcohol use and to advise young people to reduce or stop drinking, according to a study led by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health. Among students who had been seen by a doctor in the past year and who reported drinking in the past month, only 23 percent said they were advised to reduce or stop drinking. Alcohol Use from Adolescence to Adulthood Follows Different and Complex Pathways “Increased levels of exploration and risk taking seem to mark the transition from adolescence to adulthood,” said Marieke Wichers, associate professor at Maastricht University Medical Centre as well as corresponding author for the study. “From an evolutionary point of view, this boost of explorative behavior may be advantageous to adolescents in order to get to know the world around them and become independent. Thus, we see that that all over the world – on average – adolescents have higher levels of novelty seeking and are more risk taking that other age groups.” Novelty seeking is likely one of several personality factors that may influence the timing of the initiation of drinking behaviors. Many do consider teenage drinking a ‘rite of passage,’ given the ubiquity of the behavior across different environments and cultures. We found six different subgroups of individuals that could be clustered together in terms of their trajectories of alcohol use,” said Wichers. “Alcohol use in these six trajectories differed in terms of, one, overall level of use, in that some subgroups used more alcohol than others, two, peak of alcohol use, in that some subgroups had a more pronounced early peak of use in early adolescence than other subgroups, and three, persistence of use, in that two subgroups were both characterized by a sharp increase in use during adolescence and high levels of use.” “This study clearly shows that ‘one size’ or one risk factor does not fit all,” he said. “The importance of different vulnerability varies from latent class to latent class, with different risk factors affecting consumption levels and consumption patterns over time. Similarly, so does the importance of different well-known protective factors such as church attendance, parental attitudes, and parental monitoring.” Drug type: Alcohol The Federal Trade Commission has ordered the makers of Four Loko to change the look of its containers to comply with charges of deceptive marketing, the Associated Press reports. Chicago-based Phusion Projects will be required to put an “alcohol facts panel” on the back of flavored malt beverage cans containing more than two servings of alcohol. Phusion also will have to redesign cans of drinks containing more than 2 1/2 servings of alcohol so they can be resealed and the drink wouldn’t have to be consumed in one sitting. The FTC had accused Phusion of implying in ads that its supersized 23.5-ounce can of Four Loko was equal to one or two regular 12-ounce beers. In fact, the agency says, the can — which contains up to 12 percent alcohol — is really more like four to five beers. Study Links Lower Drinking Age With Increased Risk of Binge Drinking

The ability to legally buy alcohol before age 21 is associated with an increased risk of binge drinking later in life. People who lived in states with lower minimum drinking ages were not more likely to consume more alcohol overall, or to drink more frequently, compared with those in states with a legal drinking age of 21. However, when they did consume alcohol, they were more likely to drink heavily, Science Daily reports. Even decades later, men who grew up in states with a legal drinking age less than 21 were 19 percent more likely to binge drink more than once a month. Among those who did not attend college, the risk of binge drinking more than once a month rose by 31 percent. The study appears in the journal Alcoholism: Clinical & Experimental Research.

Drug type: Marijuana Recent research from Duke University in Durham, N.C., found teenagers who smoked marijuana habitually during their adolescence showed a decrease in their general intellectual ability as they progressed into adulthood. But now, there is an even more chilling possible side effect of cannabis use – an increased risk of stroke. Marijuana may double the risk of ischemic stroke and transient ischemic attack (TIA) in young adults – even those who had no risk factors that often contribute to an attack. Of the 160 stroke patients, 16 percent tested positive for marijuana use within the past couple of days, compared to only 8.1 percent of the control patients. According to Barber, the stroke patients were very well matched to the controls, with no differences in age, mechanisms for stroke or other vascular risk factors. Study Examines New Treatment for Marijuana Dependence Researchers at Columbia University

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in New York are studying a new treatment for marijuana dependence. A synthetic version of THC—the active ingredient in marijuana—called nabilone. Marijuana-dependent patients received either a placebo or one of two doses of nabilone. Marijuana potency has been increasing over the last 40 to 50 years, Dr. Cooper said. There is currently no medication approved by the U.S. Food and Drug Administration for treatment of marijuana dependence. Of people who do seek treatment for marijuana dependence, many are unable to stay abstinent, Dr. Cooper observed. In one study, 71 percent returned to marijuana use within six months. The Mounting Evidence: Cannabis May Increase the Risk for Schizophrenia in the Developing Mind A recently published report in the Journal of Translational Psychiatry sheds light on the role that cannabis plays in increasing the risk for schizophrenia in the developing brain.[1] In examination of the adolescent rodent brains that were exposed to THC, there were obvious abnormalities in fear conditioning and prepulse inhibition; both are phenomenons that are found to be skewed in cases where there are diagnoses of schizophrenia. In postmortem examinations, hippocampus cells exposed to cannabinoid activity showed degraded expression of glutamate receptors. Glutamate is critical to proper functioning of fear conditioning pathways-more evidence of brain injury. 1] Gleason KA et al. Susceptibility of the adolescent brains to cannabinoids. Long-term hippocampal effects and relevance to schizophrenia. Translational Psychiatry 2012 Nov 27; 2:e199. Researchers Develop Patch to Deliver Psychoactive Ingredient of Marijuana Researchers at the University of Mississippi have developed a patch to deliver THC, the psychoactive ingredient in marijuana. They say it could be used to treat pain, glaucoma, and the nausea and vomiting associated with chemotherapy, Mississippi News Now reports. The patch is designed to be used in the mouth, above the gum line. Drug type: Tobacco Despite increased evidence provided in the 2010 Surgeon General’s report that cigarette smoking causes disease and that no level of cigarette use is safe, 3 rates of cigarette use among certain groups of Americans remain high. One group, people who suffer from a mental illness, suffer from tobacco-related death disproportionately. Read the entire report at CDC. Drug type: Tobacco A study found that from its launch in 1989 to 2008, California’s tobacco control program reduced health care costs by $134 billion, far more than the $2.4 billion spent on the program. Additionally, the study found that California’s program helped reduce the number of cigarette packs sold by approximately 6.8 billion. . A 2011 study found that during the first 10 years of Washington state’s tobacco prevention program, the state saved more than $5 in tobacco-related hospitalization costs for every $1 spent on the program. Over the 10-year period, the program prevented nearly 36,000 hospitalizations, saving $1.5 billion compared to $260 million spent. This study was published in the journal PLOS ONE. Youth Alcohol and Marijuana Use Compromises Brain Integrity Chronic use of alcohol and marijuana during youth is associated with poorer neural structure, function, and metabolism, as well as worsened neurocognitive abilities into later adolescence and adulthood. This may be due to biological and psychosocial transitions occurring during adolescence that impart increased vulnerability to neurotoxic influences. A study of longitudinal changes in fiber tract integrity associated with adolescent alcohol and marijuana use during 1.5 years supports previous findings of reduced white-matter integrity in these youth. “Alcohol and marijuana may have a negative impact by altering important cellular communication in the brain, preventing development of new healthy cells, and/or causing inflammation, which can adversely impact healthy brain development in many ways. For example, the results can lead to changes in brain structure such as volume, and function such as activity.” Brain connections important for inhibiting risky behaviors are still forming, and some youth are more likely to choose immediate effects, such as alcohol or marijuana use, over long-term benefits.” Adolescents are vulnerable to loss of control and, when this loss of control involves substance use, excessive or risky substance use can have adverse consequences.” Evidence was found that indicated poorer white matter tissue health in teens who engage in heavy alcohol and marijuana use compared to those who abstain,” said Jacobus. She noted that white matter, the “information highway of the brain,” allows for quick and efficient communication between brain regions. Compromised white matter can mean slower cognitive processing and poorer cognitive performance such as memory, attention, and decision-making. Bava, S., Jacobus, J., Thayer, R. E. and Tapert, S. F. (2012), Longitudinal Changes in White Matter Integrity Among Adolescent Substance Users.Alcoholism: Clinical and Experimental Research. doi: 10.1111/j.1530-0277.2012.01920.x Drug type: Marijuana, Tobacco Rats previously exposed to tetrahydrocannabinol (THC), the main active ingredient in marijuana, found nicotine more rewarding than rats not exposed to THC, according to new National Institute on Drug Abuse-funded research published in Neuropsychopharmacology (Press release). Get your copy of the study abstract. Drug type: Alcohol, Tobacco In the United States, smoking remains the leading cause of premature mortality and alcohol consumption the third-leading cause of mortality. Not only does the concurrent use of cigarettes and alcohol increase risks for certain cancers, but also makes it more difficult to quit either substance. Tobacco companies not only research the link between these two products, but also use this knowledge to develop marketing strategies that reinforce concurrent use of alcohol and tobacco. More on the study and how local anti-drug coalitions can use the data to inform their efforts appears in the January/February 2013 issue of Research into Action (PDF). DMAA (1,3-dimethylamine) is

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a widely distributed over-the-counter stimulant. DMAA use is not without serious health risks. DMAA is an unpredictable chemical that has clear links to serious cardiovascular incidents, especially in situations of physical exertion. Suboxone (buprenorphine) Semi-synthetic opiate believed to have little potential for abuse was viewed by many as a cure-all for the treatment of individuals dependent on heroin and prescription opiates. Patients who abuse buprenorphine frequently report mixed symptoms of euphoria that is tempered by a sense of unease or anxiety, a rather uncomfortable set of contradictory symptoms. Chronic use of the drug can lead to dependency. Detoxification from buprenorphine is difficult. For some patients it is nearly impossible to quit. Physicians and patients using the drug as a means of titrating off of opiates need to guard against using this drug for extended periods of time. Doing so can lead to a transference of dependency from the abused opiate. [1] Karen C. Thomas, PhD, Marty Malheiro, MS, Barbara Crouch, PharmD, Utah Poison Control Center; Christina Porucznik, PhD, Department of Family and Preventative Medicine, University of Utah. Lessons in Abuse: Not All Over-the-Counter Cough Syrups Are Created Equal Whether it is DXM syrups, such as Delsym or specially flavored “lean” cocktails, cough syrup “highs” carry significant, life-threatening consequences. Making this behavior all the more risky is that overdoses and accidents have very unpredictable outcomes. Overdose deaths are not uncommon. In the United States, cough syrup abusers fall into one of two categories of use: those who seek out opiate containing products (codeine, hydrocodone, and oxycodone), and those who hunt for compounds that contain dextromethorphan (DXM). Some prescription formulas contain both types of drug in a special compound. DXM cough suppressants can be powerful drugs that often trigger a cascade of dangerous effects that are eerily similar smoking PCP. Dextromethorphan is a dissociative anesthetic and, in sufficient doses, can cause users to experience hallucinations, distortions, and disturbances in thought processes. DXM can create an out-of-body effect that users describe as a detachment from mind and body. For those abusers who are drawn to the codeine/promethazine-based products, the effects are noticeably, but not entirely different from dextromethorphan syrups. These chemicals are capable of causing significant sedation and amnesia. Cocaine Addiction Studied through Brain Activity – Written by KYLE SCROGGINS Filed under Science & Technology Research has definitively shown diminished activity in this part of the brain, implying an inability to control the urge to take more of the drug. This finding fights the notion that addicts are just weak-minded people. Rather, they are physiologically unable to stop themselves from doing the drug. The circuit in their brain that would tell them not to just isn’t firing. These feelings of helplessness may be alien to some, but for people with a real addiction, it can control their lives. Furthermore, such research begs the age-old question: which came first? Are people with less activity in the prefrontal cortex more likely to become addicted, or is the drug really damaging the prefrontal cortex? So the goal was clear: find something to reboot the damaged brain. And find something they did. Using medications already approved by the FDA, they were able to reactivate the prefrontal cortices of cocaine-addicted mice. Because our society does not fully recognize addiction as a disease, health insurance companies have very limited coverage for such medications. Commentary: Why the Term “Enabling” Does More Harm Than Good Rather than labeling a family member’s behavior as “enabling,” focus on the consequences of the addicted person’s behavior. Ask yourself – by doing this, do I allow him or her to avoid a negative consequence of the drinking or drug use? If the answer is yes, resist the urge to intervene. It is important that the person experience the negative consequences that substance abuse renders. Also ask yourself – by doing this, am I encouraging efforts he or she has made at recovery? If the answer is yes, go for it! It is helpful to recognize and show signs of support and appreciation for the hard work that an addict undertakes to sustain recovery. Coalition resources: Media Outreach SAMHSA find that overall, from 2002 to 2011, the percentage of teens receiving substance abuse prevention messages in the past year from media fell significantly – from 83.2 percent in 2002 to 75.1 percent in 2011. School-based prevention messaging also dropped – from 78.8 percent in 2002 to 74.5 percent in 2011. The report also finds that roughly 40 percent of adolescents did not talk with their parents in the past year about the dangers of substance use. The percentage of adolescents perceiving great risk from smoking marijuana once or twice a week decreased from 54.6 percent in 2007 to 44.8 percent in 2011. As the rate of perceived risk among adolescents declined, their rate of current marijuana use (use during the past month) rose from 6.7 percent in 2007 to 7.9 percent in 2011. Both reports, “Trends in Adolescent Substance Use” and “Perception of Risk from Substance Use and Trends in Exposure to Substance Use Prevention Messages among Adolescents,” are based on findings from the 2002 to 2011 National Survey on Drug Use and Health (NSDUH MENTAL HEALTH HHS/Office of Adolescent Health updates state-by-state adolescent mental health facts The Department of Health and Human Services Office of Adolescent Health has recently updated its state summaries that focus on adolescent mental health. Each state page reports on positive social skills, depressive symptoms, depressive episodes and suicidal thoughts, attempts, and injuries. Data sources include the National Survey of Children’s Health, 2007; Youth Risk Behavior Survey, 1991-2011 and State Estimates of Substance Use and Mental Disorders from the 2009-2010 National Surveys on Drug Use and Health. More information PA 2-1-1 Southwest’s online search for services The new site is a comprehensive list of providers throughout the southwest PA region. Users have quick access to assistance with housing, utilities, and food or can expand their search for other needs. The site can be searched by need, location, or provider agency, or by a combination of elements. All provider information has been supplied by the providers themselves, and will be reviewed and updated regularly. Questions or suggestions regarding the site can be sent to info@pa211sw.org. PA 2-1-1 Southwest is a FREE resource and information hub that connects people with community, health and disaster services in 11 counties through a free, 24/7 confidential phone service and website. To reach them by phone, dial 2-1-1 or 888-553-5778 (Toll-Free). If you have a hearing impairment, you can dial 7-1-1 and ask to be connected to 2-1-1. Is Drinking Soda Linked to Depression? A new study suggests that people who drink moderate amounts of sweetened sodas and fruit drinks are at an increased risk of depression.[1] Previous studies of soda effects indicated that the drinking of sweetened beverages (diet or otherwise) was associated with a higher prevalence of depression as well as various forms of mental stress and dangerous suicidal ideations. A recently published study was more rigorous than prior investigations; Since 2000, over 11,000 respondents answered “yes,” that they had in fact been diagnosed with depression. Published at a recent annual conference of the American Academy of Neurology, researchers learned the following about respondents:

  • People who drank more than four cans or cups of soda per day were 30% more likely to develop depression than those who did not drink soda at all.
  • People who drank four cans or more of fruit punch per day were 38% more likely to develop depression than those who did not drink sweetened beverages.
  • People who drank diet, sweetened beverages were at a greater risk for developing depression than were those who drank sugar sweetened beverages.
  • People who drink coffee seem to be slightly protected from depression. But you have to drink at least four cups a day in order to enjoy the benefits. Those who drink four cups a day are 10% less likely to develop depression than those people who drink no coffee.

For a sober living addict, it may be that soda is antithetical to reacquisition of a balanced mood and persona. [1] Chen, H, MD, PhD (2013). Hold the diet soda? Sweetened drinks linked to depression, coffee tied to lower risk. 2013 Jan 8.

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