FYI: From the Field

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Press Release: Massachusetts General Hospital

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Press Release: Journal of Studies on Alcohol and Drugs

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Reprinted with permission from JoinTogether.org.

Reprinted with permission from JoinTogether.org.

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Reprinted with permission from JoinTogether.org.

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Reprinted with permission from JoinTogether.org.

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Scottish Health Action on Alcohol Problems

Moms and dads who grew up in the 60s, 70s and 80s have long struggled with a fundamental question of parenting: what to say when your children ask you about your own drug use?

In the past, parents have been advised to dodge the subject, "just say no," or take a do-as-I-say-not-as-I-did approach without going into details about their not-so-spotless past. On the other end of the spectrum, a group of California educators advises marijuana-using parents to discuss drug dangers and encourage abstinence, but also address responsible use in case their kids decide to drink or use illicit drugs, anyway.

The latest research from the Hazelden Foundation, however, comes down firmly on the side of truthfulness when it comes to discussing drugs with kids. "With 54 percent of students admitting to using drugs by the time they leave high school and 50 percent using alcohol by eighth grade, it's vital that all generations break through the stigma and speak openly about addiction and the benefits of treatment and recovery," said Hazelden CEO Mark Mishek.

Hazelden's Four Generations Overcoming Addiction survey finds that about half of parents admit that they got drunk or high as teens, and one in four teens say they have seen their parents get drunk or high. Still, more than 90 percent of both parents and teens see parents as role models on drug-use issues, whether or not the adolescents were aware of their parents own drug use.

Moreover, 63 percent of teens believe that hearing the stories about their parents' past use of alcohol and other drugs would make them more responsible, in turn. In fact, half of the teens surveyed said that they would be less likely to use drugs if parents shared their past drug experiences.

Of the two-thirds of teens whose parents had spoken to them about their own experiences, 95 percent said that they appreciated their parents' honesty. And 68 percent of teens whose parents had not had such a frank discussion said they wished they would.

Three-quarters of parents who did not talk to their kids about their past drug use said they avoided the topic because they didn't want their children to emulate their behavior. However, Hazelden researchers found that most kids viewed their parents as the best source of advice on drug use, even if they had seen their parents drunk or high themselves.

"The responses Hazelden received from hundreds of parents and teens suggests that it's time for parents to rethink what being a 'role model' really means," said Marvin Seppala, chief medical officer at Hazelden. "It's not enough to cling to 'Just Say No' and pretend that today's parents didn't have their own experiences with alcohol and other drugs when they were younger. Teens say they want their parents to be honest and that such openness will lead these teens to be more responsible about their use."

A recent report from the Partnership for a Drug Free America makes clear that one thing parents should not do is avoid talking to their kids about alcohol and other drug abuse. The 2008 Partnership Attitude Tracking Study found that 37 percent of teens surveyed said they had learned a lot from talking to their parents about drug use, and PDFA President and CEO Steve Pasierb said that adolescents appear to be "more open to talking about the drug issue than kids in the past."

Researchers at Brigham Young University also reported that children with parents who let them know they disapprove of drug use are less likely to use.

The PATS study also found in recent years that fewer parents are talking to their kids about drugs. However, the Hazelden study suggests that "a major shift has occurred in the course of one generation, as parents of today's teenagers are much more open with their children about their early use of drugs than were their own parents at the time," according to a press release on the survey.

"Sixty-three percent of parents said that when they were teens, their parents told them 'nothing' about their use of drugs when they were teenagers," Hazelden noted. "In contrast, among the 47 percent of parents surveyed who said they'd used alcohol or drugs to get drunk or high as a teenager, over three quarters (77 percent) said they had spoken with their teenage children about it."

The Hazelden study, conducted by Ipsos Public Affairs, also found that:

    * Teenage girls are more likely than are teenage boys to wish their parents would share information about their past drug use (74 percent vs. 61 percent).

    * 83 percent of teens said that they expect to someday tell their own teenage children about their use of alcohol or drugs; only 17 percent said they would withhold such information.

    * 63 percent of parents who withheld information about their own drug past said it was none of their children's business, while 62 percent said they feared such a disclosure would make their children think that drinking or using illicit drugs is okay. Additionally, 26 percent of non-disclosing parents said their children were too young for such a talk, while 21 percent said the subject never came up. Only 6 percent of parents said they didn't talk about alcohol or other drugs because they felt unqualified to do so.

    * Just 2 percent of teens said that parental disclosure of past drug would make them act less responsibly.

The conclusions were drawn from national samples of 603 boys and girls ages 15-18 and 620 parents of teens ages 15-18.

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Reprinted with permission from JoinTogether.org.

A new study from the Kellogg School of Management concludes that most people have too much faith in their own ability to resist temptations such as drugs, sex, and greed.

Researcher Loran Nordgren and colleagues cite a "restraint bias" that causes people to overestimate their willpower and increases the risk of engaging in addictive or impulsive behavior. A series of experiments to gauge impulse control included testing the willpower of smokers to abstain after watching a movie about smoking.

"People are not good at anticipating the power of their urges, and those who are the most confident about their self-control are the most likely to give into temptation," Nordgren said. "The key is simply to avoid any situations where vices and other weaknesses thrive and, most importantly, for individuals to keep a humble view of their willpower."

"A system which assumes people will control themselves is going to fall prey to this restraint bias; we expose ourselves to more temptation than is wise, and subsequently we have millions of people suffering with obesity, addictions and other unhealthy lifestyles," explained Nordgren.

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Psychological Science

From a biological perspective, taking that first drink at a young age “may induce changes in the highly sensitive adolescent brain, which may also modify an individual's subsequent genetic vulnerability to alcoholism,” Arpana Agrawal, an assistant professor of psychiatry at Washington University School of Medicine and an author of the study, said in a university news release.

The younger people were when they had their first drink, especially if that occurred before age 15, the more symptoms of alcohol dependency they developed, the study found. Early drinkers also tended to have an increased genetic vulnerability for alcohol.

Those who had their first drink later in life showed far fewer signs of alcohol dependency, despite the genetic predisposition, Agrawal noted. This suggests that alcohol dependency among those who started drinking later, “while less common, are attributable to unique experiences of those individuals -- for example, a traumatic life event,” she said.

Carol A. Prescott, a professor of psychology at the University of Southern California, said the findings had two possible conclusions. “Early drinking changes the course an individual is on, and is thus a direct cause of increased risk of alcoholism, and early drinking is correlated with alcoholism risk and is thus an indirect indicator of risk risk,” she said.

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Alcoholism: Clinical & Experimental Research

"Now it's a pleasure to live. That's what motivated me," said Joe, who asked that his real name be withheld.

Joe's sleeping problem isn't unusual in alcoholics. A study published Thursday in the journal Sleep, found that trouble with sleep while recovering can be equally difficult for both men and women, even two years into sobriety. Not sleeping can then lead to other problems, researchers said.

“Sleep problems are ubiquitous when drinking is a problem,” said Ian Colrain, director of the SRI International Human Sleep Research Program in Menlo Park, Calif. “Trouble sleeping is a common reason people relapse into drinking.”

Colrain’s federally funded study showed both men and women recovering alcoholics have less deep sleep and therefore poorer sleep quality than non-alcoholics, even two years after their last drink. The study also found that an increase of REM sleep, the stage of sleep characterized by rapid eye movement and dreaming, continued beyond the first stages of recovery.

“These long-term effects indicate changes in brain structure that lead to persistent problems,” Colrain said.

Recovering alcoholics who have trouble falling asleep and staying asleep must resist using alcohol as a sleep aid. It will take time, but sleep will get better. Steven Hart, director of Hazelden’s Chicago location, a nationally operated outpatient rehabilitation center, advised recovering alcoholics to learn how to relax with new stress management techniques. He said even common solutions including drinking warm milk and avoiding coffee, smoking and napping should help.

“Pay attention to your new sleep habits,” Hart said. “Eventually you will get back to normal sleep, but sometimes sleep patterns are permanently altered.

To anyone struggling with an alcohol addiction, Joe says, “Give yourself a chance. In the beginning, there was a fear that I was either going to die as an alcoholic or live as an alcoholic. Now I’m a recovering alcoholic and I didn’t know that was possible.”

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Reprinted from Medill Reports, Northwestern University

Researchers at the University of California at San Francisco (UCSF) are investigating a variety of possible uses for LSD, such as psychiatric applications or to treat chronic headaches. "Psychedelics are in labs all over the world and there's a lot of promise," said Rick Doblin of the Multidisciplinary Association for Psychedelic Studies in Santa Cruz. "The situation with LSD is that because it was the quintessential symbol of the '60s, it was the last to enter the lab."

The fact that researchers like Timothy Leary were among the proponents of recreational use of the drug helped keep LSD blacklisted on many research campuses. "That put a lot of researchers off, and it made it very hard for researchers to justify getting back into the field. And there were no pressing health needs, no pressing treatments other than curiosity," said UCSF researcher John Mendelson.

The studies on LSD began about a year ago; the UCSF researchers are looking at how the drug affects the brain. The school began researching other hallucinogens, like ecstasy, about a decade ago. UCSF and Harvard University are currently the only schools in the U.S. to be running human studies on LSD.

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Reprinted with permission from JoinTogether.org.

Alcohol use can disrupt the body's natural clock and sleeping patterns for days after consumption ends, according to a new animal study.

Science Daily reported Sept. 1 that a study of hamsters given doses of alcohol found that drinking affects the "master clock" in the brain, hindering its ability to sync the body's schedule to daylight and darkness and affecting circadian rhythm for days at a time.

This disruption has wide-ranging affects on sleep, appetite, digestion, activity levels, and more. It also may raise the risk of cancer, heart disease, depression, and other illnesses.

Animals in the study exposed to alcohol tended to wake up more slowly when exposed to dim light, had fewer bouts of activity during the day, and woke up earlier than other hamsters when withdrawn from alcohol for 2 to 3 days. The alcohol-using hamsters also were unnaturally active at night.

The study appears in the September 2009 issue of the American Journal of Physiology – Regulatory, Integrative and Comparative Physiology.

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Reprinted with permission from JoinTogether.org.

For the study, more than 7,200 undergraduate students ages 17-24 were prescreened for alcohol use. Those classified as engaging in harmful or hazardous drinking were assigned to either a control group or to receive online motivational feedback therapy.

After one month, participants receiving intervention drank less often, smaller quantities per occasion and less alcohol overall than did controls, according to the researchers, who also noted that the effects for overall and per-occasion consumption persisted at a six-month follow-up. Differences in alcohol-related harms were not significant, however.

 "Given the scale on which proactive Web-based electronic screening and brief intervention (e-SBI) can be delivered and its acceptability to student drinkers, we can be optimistic that a widespread application of this intervention would produce a benefit in this population group," the authors wrote, adding: "The e-SBI, a program that is available free for nonprofit purposes, could be extended to other settings, including high schools, general practices and hospitals."

The study appears in the Sept. 14, 2009 issue of the Archives of Internal Medicine.

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Reprinted with permission from JoinTogether.org.

Smoking is widely prevalent among individuals with mental illnesses, but many doctors are loathe to encourage such patients to quit out of a misguided fear that doing so will exacerbate their mental problems, Science Daily reported Sept. 9.

"These doctors and mental-health specialists focus on their patients' psychiatric health and lose track of their physical health," said Northwestern University assistant professor and health psychologist Brian Hitsman, who recently published a guide for doctors who want to help mental-health patients quit smoking. "Tobacco cessation gets a lot of attention, but we leave out a population that smokes the majority of all the cigarettes."

An estimated 40 to 80 percent of people with mental illnesses are daily smokers. However, mental-health patients get treatment for smoking on just 12 percent of visits to psychiatrists and 38 percent of visits to primary-care physicians, according to Hitsman.

Contrary to popular belief, no research has shown that psychiatric symptoms get worse when smokers quit; in fact, said Hitsman, some studies have shown that psychiatric patients actually improve during smoking-cessation treatment.

"The perception is patients need tobacco because it's their only source of pleasure and helps them feel better," he said. "There is very little evidence, though, that smoking cigarettes serves to self-medicate emotional symptoms."

Hitsman's smoking-cessation plan appears in the June 2009 issue of the Canadian Journal of Psychiatry.

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Reprinted with permission from JoinTogether.org.

The New York Times reported Sept. 2 that researchers who studied male and female drinkers at bars near college campuses found that those who paid the most money per gram of alcohol consumed were the least intoxicated when given breath tests upon exiting. The least intoxicated patrons paid an average of $4.44 for 14 grams of alcohol (in the form of beer, wine or liquor), while those found to be the drunkest had paid $1.81 for the same amount of alcohol.

Bars in the areas studied offered "all you can drink" specials for $5 to $7, and researchers from the University of Florida and San Diego State University found that most of the young patrons had tight budgets and were seeking the most "bang for their buck."

"These findings do warrant a discussion about the unintended consequences of cheap alcohol, especially among the price-sensitive college student population, which has a well-documented history of alcohol-related problems," said researcher Ryan J. O'Mara of the University of Florida.

The study is published online and slated to appear in the November 2009 issue of the journal Alcoholism: Clinical and Experimental Research.

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Reprinted with permission from JoinTogether.org.

A 2009 online survey at a large Midwestern university found that the majority of students were not familiar with the term “high” in relation to alcohol intoxication and the term “drunk” was associated with a generalized level of intoxication that could not be easily categorized as moderate or heavy intoxication, as could the other terms used by college students. Instead, students used multiple other terms to describe moderate and heavy levels of alcohol intoxication, and these terms varied slightly according to gender.

The authors suggest that self-report surveys may be more effective if they include multiple intoxication-related terms that are 1) often used by drinkers as self-descriptors and 2) represent both moderate (e.g., buzzed, tipsy, light-headed) and heavy intoxication (e.g., trashed, wasted, hammered). They also suggest that researchers “periodically assess current intoxicated-related vocabulary considering demographic, generational, and socio-cultural differences.”

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Center for Substance Abuse Research

Brain damage caused by excessive drinking can impair the ability to read facial expressions and blunt emotions even among those in long-term recovery from alcoholism, Science Daily reported Aug. 12.

Alcohol-related deficits in the amygdala and hippocampus regions of the brain can hinder the ability of current and former alcoholics from maintaining healthy relationships, researchers said. Study author Ksenija Marinkovic of the University of California at San Diego and colleagues based their conclusions on studies using functional MRI scans.

"Alcoholics also have problems in judging the emotional expressions on people's faces," said Marinkovic. "This can result in miscommunication during emotionally charged situations and lead to unnecessary conflicts and difficulties in interpersonal relationships. The resulting negative repercussions can, in turn, contribute to increased drinking."

"The neuroimaging evidence from our study suggests that deficient activation of limbic structures inside the temporal lobes -- the amygdala and hippocampus -- may underlie emotional difficulties in abstinent long-term alcoholics," explained Marinkovic.

"Whereas nonalcoholic adult men showed stronger activation in the amygdala and hippocampus when viewing faces with emotional expressions, the alcoholics showed decreased activation in these brain areas, and furthermore responded in an undifferentiated manner to all facial expressions. The alcoholics also were impaired on the intelligence-appraisal task, possibly due to their dampened amygdala activity."

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Reprinted with permission from JoinTogether.org.

The study also showed that the vast majority (96 percent) of young adults needing, but not receiving, specialized treatment for these substance use problems did not perceive their need for help.  Even among the 4 percent of young adults who thought they needed specialized help in the past year, but who had not received it, less than one third made any attempt to get treatment. 

Among young adults, 17.2 percent needed treatment for alcohol disorders in the past year, 8.4 percent for illicit drug disorders and 4.4 percent for a combination of alcohol and illicit drug disorders.

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Substance Abuse and Mental Health Services Administration

A new study from the Kellogg School of Management concludes that most people have too much faith in their own ability to resist temptations such as drugs, sex, and greed.

Researcher Loran Nordgren and colleagues cite a "restraint bias" that causes people to overestimate their willpower and increases the risk of engaging in addictive or impulsive behavior. A series of experiments to gauge impulse control included testing the willpower of smokers to abstain after watching a movie about smoking.

"People are not good at anticipating the power of their urges, and those who are the most confident about their self-control are the most likely to give into temptation," Nordgren said. "The key is simply to avoid any situations where vices and other weaknesses thrive and, most importantly, for individuals to keep a humble view of their willpower."

"A system which assumes people will control themselves is going to fall prey to this restraint bias; we expose ourselves to more temptation than is wise, and subsequently we have millions of people suffering with obesity, addictions and other unhealthy lifestyles," explained Nordgren. "And, while our study focused on personal behaviors like smoking and eating, it is easy to apply our findings to a broader context. Understanding the power of temptation, you might also ask about the extent to which we need oversight or regulatory guidelines for business and political leaders."

The study will appear in an upcoming issue of the journal Psychological Science.

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Reprinted with permission from JoinTogether.org.

By Bob Curley; Reprinted with permission from JoinTogether.org.

The San Francisco Chronicle reported July 16 that Mary Brennan of suburban Chicago began drinking at age 10 with friends of her older brother; by 15, she was bringing vodka to school in Gatorade bottles and getting drunk every day. Her father, a single parent, didn't recognize the problem, even after she overdosed and nearly died.

The underage-drinking rate in the U.S. has remained steady in recent years, but some research indicates that youths are starting to drink at a younger age. One study, from the Partnership for a Drug-Free America, concluded that about 10 percent of nine-year-olds had consumed more than a sip of alcohol. And research from the National Institute on Alcohol Abuse and Alcoholism indicates that children who begin drinking before age 15 are four times more likely to have drinking problems than those who start drinking at age 21 or later.

"A third of kids ages 12 to 17 had their first drink before 13," said Susan Foster, director of policy research for the National Center on Addiction and Substance Abuse (CASA) at Columbia University. "That's about 6.4 million kids, many more than there have been historically. Very young drinkers are a huge concern."

"We've received calls from parents of kids as young as 8," said Cole Rucker, CEO and cofounder of the Echo Malibu treatment center. "Every year, alcohol use shows up in younger and younger kids."

Young drinkers often get started with alcohol use by getting drinks from friends or family liquor cabinets. Polls have shown that youths ages 13 and up say it is easy to get alcohol from adults -- and sometimes their own parents, who may themselves have drinking problems.

"The traditional thinking is that risk factors for alcohol abuse show up in adolescence," said Robert A. Zucker, Ph.D., director of the Addiction Research Center at the University of Michigan. "But, actually, they can show up earlier -- in children 9 or younger, even in preschoolers."

Few treatment programs exist for very young alcoholics, who rarely get adequate services, such as intensive inpatient care.

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Reprinted with permission from JoinTogether.org.

The jail -- the first of its kind in Canada -- would send prisoners with such issues to rehab or secure substance misuse or psychological treatment facilities.

Rick Hanson, chief of police, who conceived of the "safe jail" as part of his plan to clean up the city's downtown of criminals, said that too often people commit thefts and burglaries to buy drugs and alcohol.

"Let's use the justice system to allow us to incarcerate them in a secure treatment facility so you're actually making a concerted effort to treat addiction, and then hand them off to so many of our social agencies in town who are prepared to deal with them on a long-term basis," Hanson said. "The risk to not try it is far too high."

The concept has gained support from some of Alberta's top officials.

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Reprinted with permission from JoinTogether.org.

The June 14-17 telephone poll found that 64 percent of adults said they drink alcohol, roughly the same amount as a year ago.

That figure has changed little -- varying between 3 or 4 percentage points -- since 1947. The number fluctuated slightly between 1974 and 1981, when 68 percent to 71 percent of Americans said they drank alcohol.

The June survey interviewed over 1,000 adults nationwide and had a sampling error of three percent.

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Reprinted with permission from JoinTogether.org.

Bartenders and other bar and restaurant workers still drink plenty: food-service workers have the third-highest rate of heavy alcohol use and the highest rate of illicit-drug use, according to the U.S. Department of Health and Human Services. However, more employers are frowning on drinking on the job, and fewer are willing to pay for workers' drinks at the end of shifts.

For industry workers in recovery, challenges include being exposed to alcohol on a nightly basis and, for some, job duties that include tasting drinks. Del Pedro, for example, is a bartender at the Pegu Club in New York and an expert at mixing drinks. Fifteen years sober, his job requires him to taste new alcoholic concoctions before they are served.

Pedro's solution: he tastes, then spits. In the eyes of fellow recovering alcoholics he may not be technically sober, but Pedro does no recreational drinking and says that if tasting leads to imbibing, he'll quit.

Some employers in the industry, like the Lettuce Entertain You group, train managers to assist workers who may be struggling with addiction. The Culinary Institute of America is grappling with the issue of how to accommodate students in recovery, and has sponsored lectures about recovery and cooking without alcohol.

Addiction "is one of the downfalls of our business," said Gale Gand, a partner at Tru restaurant in Chicago. Gand said that there are more sober workers in restaurants than ever -- a reflection of the growing size and professionalism of the industry -- and that non-drinking employees are welcomed in most jobs.

"Service is so much about reading other people and verbal skills and eye-hand coordination," Gand said. "We have waiters who are allergic to chocolate and they can still serve chocolate desserts. And certainly, when Beethoven went deaf he could still write music."

Still, many bartenders and restaurant workers who are in recovery hesitate to publicly identify themselves out of fear that it might cost them their jobs.

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Reprinted with permission from JoinTogether.org.

The woman, Stacey Anvarinia, faces five years in prison, and the case has been the subject of intense online discussions, especially on blogs for women and mothers. "Since when is breast-feeding while drunk a crime?" said Amy Tuteur, a retired obstetrician and gynecologist who wrote about the case on her Skeptical OB blog. "No one would have bothered to check what was in the bottle" if Anvarinia was bottle-feeding her child, Tuteur said. "You can do a lot more damage by mixing formula wrong."

The La Leche League International advises only "completely sober" women to breast-feed. "Drinking to the point of intoxication, or binge drinking, by breast-feeding mothers has not been adequately studied," the group says. "Since all of the risks are not understood, drinking to the point of intoxication is not advised."

Drowsiness, weakness and abnormal weight gain can affect infants whose mothers drink before breast-feeding, according to the American Academy of Pediatrics, but the group also said that limited alcohol use is OK for breast-feeding moms.

"A mother who becomes intoxicated should not breast-feed," said pediatrician Lori Feldman-Winter, the group's head of policy on breast-feeding "After drinking one glass of wine, a woman should abstain from breast-feeding for two to three hours."

Police never tested Anavarinia's blood-alcohol content. Past attempts to prosecute women for similar offenses have met with limited success.

The Associated Press reported June 26 that researcher Dan Selvage said that high levels of stress hormones can disrupt the body's natural feedback and lead to health problems being missed.

"If you have an infection, you won't notice the symptoms of it until it gets much worse because the stress hormones are blocking the way your body would respond to it and take care of it," Selvage said.

Researchers have found that alcohol increases production of estrogen in women, which is related to increased stress responses. The problem may be particularly acute in post-menopausal women.

"Females tend to suffer the ravages of alcoholism much more quickly than males," said Selvage. "Part of that's due to metabolism, but another part of that is thought to be that alcohol activates body stress responses a lot more in females."

The ongoing research could lead to new ways of treating alcohol-related problems in women, said Selvage. "We really look throughout the brain to see what brain pathways are involved in receiving this noxious alcohol," he said. "The whole idea is to come up with ways to try and block that stress response as well as you can."

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Reprinted with permission from JoinTogether.org.

Addiction is not a disease but rather a behavior that can be controlled, according to a Harvard psychologist who points to the fact that some addicts can voluntarily quit using to support his hypothesis.

 The Toronto Star reported May 16 that Gene M. Heyman, author of the new book, Addiction: A Disorder of Choice, writes that the public has been deceived by addiction experts. He agrees that individuals can be genetically predisposed to addiction, and that changes occur in the brains of addicts, but contends that the decision to use or quit remains voluntary.

 Heyman disputes the notion that addiction is a lifelong illness, saying that the research underpinning this theory is skewed by the fact that studies tend to look at people who have sought treatment, not those who quit on their own and never use again.

 People do not choose to become addicts, Heyman agrees, but while most addiction experts point to changes in the brain as the underlying reason for relapse, Heyman sees the issue as primarily one of self-control.

 Heyman's take on addiction doesn't sit well with many experts in the field, who note that many addicts can't change their behavior despite devastating personal consequences, such as loss of health, family, and job.

 "Where (Heyman) loses the argument is that there are clearly both biological and environmental or contextual factors involved, but he's basically saying that the context and the environment are everything and the biology is irrelevant," said Tony George, head of addiction psychiatry at the University of Toronto. "Well, what we know about the brain, and the brain on drugs, is startling." 

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Reprinted with permission from JoinTogether.org.

The U.S. government and experts from academia are looking for new ways to treat the growing number of American troops with addiction problems and post-traumatic stress disorders, Fox News reported.

 "Substance-abuse disorders are much more prevalent among individuals that have been exposed to war environments, as are other psychiatric disorders," said Nora Volkow, director of the National Institute on Drug Abuse (NIDA). "So the outcomes of these individuals, if not properly addressed, can be very poor."

 NIDA, the Pentagon, the Department of Veterans Affairs (VA) and academic experts are developing treatment protocols and outcome measures, and plan to issue a final report in about two months.

 Thomas Kosten, a psychiatry and neuroscience professor at Baylor College of Medicine in Texas and head of the VA's program investigating treatment modalities aimed at the needs of soldiers, sailors and airmen, said that binge drinking is common among veterans of the Iraq and Afghan wars. Nearly 3 percent of returning troops use opiate painkillers, and the smoking rate among returning troops is more than double that of the general population, Kosten said.

A RAND Corporation study concluded that over 18 percent of U.S. troops sent to Iraq and Afghanistan exhibit signs of either PTSD or depression. "This new combination of moderate traumatic brain injury along with post-traumatic stress disorder and the substance abuse has been very difficult to treat," Kosten said. "We're seeing things that we, quite frankly, haven't seen before in terms of having to treat them."

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Reprinted with permission from JoinTogether.org.

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Reprinted with permission from CESAR, University of Maryland

The study found that when the gene -- dubbed "happyhour" by researchers -- was switched off by blocking its action with an anticancer drug called Tarceva, the flies became more sensitive to alcohol and drank less. The drug, like the gene, acts on a cellular network called the EGF pathway.

"People who are very sensitive to alcohol tend to drink less -- that's the person who gets drunk on one glass of wine," noted Brown University psychiatrist Robert Swift. "The person who can drink everybody under the table -- that's that person who is more likely to become an alcoholic."

Researcher Ulrike Heberlein of the University of California at San Francisco and colleagues found the gene by studying mutant fruit flies that could outdrink other flies. In past studies, Heberlein's team discovered a gene called "cheapdate" that makes flies highly sensitive to alcohol.

"I'm very much looking forward for [Tarceva] to be tested in humans, and it's quite possible one wouldn't need the doses used in chemotherapy to treat addicts," said Heberlein.

The study was published in the May 21, 2009 issue of the journal Cell.

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Reprinted with permission from JoinTogether.org.

For example, research shows that roughly 7 percent of people exposed to terrorist attacks reported an increase in alcohol consumption, Science Daily reported May 13.

Researchers at Columbia University Mailman School of Public Health reviewed previously published studies conducted after the terrorist attacks of September 11, 2001, the Oklahoma City Bombings (1995), and the Intifada uprisings in Israel and Palestine (though most of the data was based on the 9-11 attacks). Lead author Charles DiMaggio and colleagues looked for changes in addictive behavior and found that 7.3 percent of respondents reported more or problematic alcohol consumption.

Though the researchers cautioned that their findings are fraught with variability, DiMaggio said, "These kinds of numbers indicate the potentially pervasive behavioral health effects of man-made disasters like terrorism. We hope our results can help direct interventions following terrorist incidents."

The findings were published online April 9, 2009 in the journal Addiction.

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Reprinted with permission from JoinTogether.org.

The vast majority of the estimated $467.7 billion in substance-abuse related spending by governments on substance-abuse problems went to deal with the consequences of alcohol, tobacco and other drug use, not treatment and prevention, according to a new report from the National Center on Addiction and Substance Abuse (CASA) at Columbia University.

The report, titled, "Shoveling Up II: The Impact of Substance Abuse on Federal, State and Local Budgets," found that 95 percent of the $373.9 billion spent by the federal government and states went to paying for the societal and personal damage caused by alcohol and other drug use; the calculation included crime, health care costs, child abuse, domestic violence, homelessness and other consequences of tobacco, alcohol and illegal and prescription drug abuse and addiction.

Just 1.9 percent went to treatment and prevention, while 0.4 percent was spent on research, 1.4 percent went towards taxation and regulation, and 0.7 percent went to interdiction.

"Such upside-down-cake public policy is unconscionable," said Joseph A. Califano, Jr., CASA's founder and chairman. "It's past time for this fiscal and human waste to end."

CASA estimated that the federal government spent $238.2 billion on substance-abuse related issues in 2005, while states spent $135.8 billion and local governments spent $93.8 billion. The report said that 58 percent of spending was for health care and 13.1 percent on justice systems.

Researchers estimated that 11.2 percent of all federal and state government spending went towards alcohol, tobacco and other drug abuse and addictions and its consequences. The report said that Connecticut spent the most proportionately on prevention, treatment and research -- $10.39 of every $100 spent on addiction issues -- while New Hampshire spent the least -- 22 cents.

Learn more and get the report

State-by-state spending

Introduction and Executive Summary (PDF, 541 KB)

Full Report (PDF, 4.3 MB)

Order print copies

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Reprinted with permission from JoinTogether.org.

The study, which was supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institutes of Health, and the National Institute on Drug Abuse (NIDA), followed a group of 11-year-olds for two-and-a-half years. Study participants who participated in a family-centered prevention program were compared to a group that did not receive interventions.

The researchers found that program participants who carried the short allele form of 5-HTTLPR -- a form of the gene that is associated with impulsivity, low self-control, binge drinking and substance use -- were no more likely to engage in risky behavior than those without the gene who were enrolled in the program.

By contrast, adolescents carrying the gene who were not in the program were twice as likely to take part in risky behaviors as those carrying the gene in the prevention program.

"We found that the prevention program proved especially beneficial for children with a genetic risk factor tied to risky behaviors," said lead author Gene Brody. "The results emphasize the important role of parents, caregivers, and family-centered prevention programs in promoting healthy development during adolescence, especially when children have a biological makeup that may pose a challenge."

The study was published online May 15, 2009 in the journal Child Development.

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Reprinted with permission from JoinTogether.org.

Researcher Maria Nilsson evaluated the impact of an anti-smoking program, Tobacco-Free Duo, which started in 1993. The program targets children between the ages of 13-15 and includes adults supporting the teenagers in staying tobacco-free.

Nilsson found that smoking rates declined among adolescents in the program over a seven-year period, while no corresponding change was observed at the national level. In addition, one in four tobacco-using adults participating in the program stopped smoking in order to take part.

"Children expect adults to work against tobacco. They say this is important and that grown-ups can make a difference by showing a clear and positive commitment," said Nilsson.

Survey results on 15-year-old smokers showed that close relationships with caring adults played an important role in getting teenagers to smoke less or stop smoking all together.

The findings are part of Nilsson's dissertation, Promoting Health in Adolescents: Preventing the Use of Tobacco.

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Reprinted with permission from JoinTogether.org.

Most people who drink alcohol are not alcoholics and never will be. But the National Institute on Alcohol Abuse and Alcoholism knows all too well that millions of Americans drink in amounts or patterns that put them at risk of developing a dependence on alcohol and having to face the attendant medical, legal and social problems.

Based on a 2001-02 nationwide survey of 43,000 adults conducted by the National Institutes of Health, the alcohol institute estimates that 30 percent of people 18 and older drink at levels that raise their risk of alcoholism. And since helping those people identify themselves before they get into trouble with alcohol is easier than treating alcoholism, the institute has begun a groundbreaking preventive program called Rethinking Drinking.

The program includes a 16-page booklet for the public (“Rethinking Drinking: Alcohol and Your Health”), a product set for clinicians with a 34-page booklet (“Helping Patients Who Drink Too Much: A Clinician’s Guide”) and an interactive Web site for people who drink, RethinkingDrinking.niaaa.nih.gov, complete with quizzes, calculators and other tools.

The materials can be downloaded from the Web site or ordered by phone at 301-443-3860. Together, they represent a sea change in the approach to alcohol abuse: identify and treat risky drinking patterns before anything bad happens.

Making Adjustments

“This is a wellness project, patterned on the risk-reduction concept used to prevent other chronic diseases like heart disease and diabetes,” Dr. Mark Willenbring, the main architect (with Maureen Gardner) of the program, said in an interview. “As with lowering cholesterol or high blood pressure to prevent heart disease, the idea is early identification of risky drinking patterns and early intervention instead of waiting until the person is chronically ill.”

Dr. Willenbring, who directs the institute’s Division of Treatment and Recovery Research, added: “Once they know who they are, most people at risk of becoming alcohol abusers can cut down on their alcohol consumption and reduce their risk. We know that many heavy drinkers are able to change on their own.”

For those who already drink at abusive levels, the new program can help them acknowledge their problem and seek treatment earlier, before they suffer irreversible medical and social problems like liver or brain disease, legal difficulties, job loss or divorce.

The beauty of Rethinking Drinking is that it can be used in the privacy of the home or in a doctor’s office, sparing people the embarrassment and stigma that often accompany public acknowledgment of a problem with alcohol and entering a treatment program.

“A single session with a physician — just five minutes of advice — can have lasting effects on reducing a person’s drinking,” Dr. Willenbring said. Yet many primary care doctors don’t know how to identify a potential drinking problem in their patients or what to do if they suspect a problem may develop.

“More than 90 percent of alcohol treatment programs offer group counseling or Alcoholics Anonymous,” Dr. Willenbring noted. “This is not a medical model. Doctors are not involved.”

The Rethinking Drinking materials can also be used in other settings, like college campuses, workplaces and churches, and in the criminal justice system. A student who repeatedly wakes up hung over without knowing what he did the night before might consult the program and modify his behavior. Someone who is cited for driving while intoxicated might be referred to the program and prompted to take better control of his or her drinking before a disaster occurs.

Helpful Guidelines

Many drinkers have mistaken notions of what constitutes “a drink” and are often unaware of just how much alcohol they consume at any one time, Dr. Willenbring said.

Rethinking Drinking provides these equivalents of one drink: 12 ounces of regular beer = 8 to 9 ounces of malt liquor = 5 ounces of table wine = 1.5 ounces of 80-proof hard liquor. Thus, one bottle of wine equals five drinks. Forty ounces of malt liquor or a half-pint of hard liquor equals four and a half drinks. Also, many light beers have nearly as much alcohol as regular beer, and a single mixed drink can contain three or more standard drinks.

The institute defines low-risk drinking, for men, as consuming no more than 4 drinks on any day and no more than 14 drinks a week. For women, the limit is three drinks on any day and no more than seven drinks a week. Drinking more than these amounts in a day or during a week is considered at-risk or heavy drinking.

Even within these limits, some people can have problems with alcohol, especially those with health problems and people over 65. Older men and women are advised to consume no more than three drinks a day and seven a week.

“Even moderate levels of drinking (up to two drinks per day for men or one for women) can be too much in some circumstances,” the program states. And people in these circumstances should avoid alcohol altogether:

¶Women who are pregnant or trying to become pregnant (a safe level of alcohol for the developing fetus has not been established).

¶People planning to drive or operate dangerous machinery.

¶Those taking medications that interact with alcohol.

¶People with health problems made worse by alcohol

The new program helps drinkers determine whether they are ready to change their drinking habits, identify personal benefits of making a change and recognize possible roadblocks and ways around them. It also provides nine strategies for cutting down on drinking, including learning how to pace yourself and keep track of how much you are drinking.

Dr. Willenbring listed five early symptoms that indicate a drinker already is an alcohol abuser or is at risk:

1. Repeatedly drinking more than self-set limits.

2. Having a persistent desire to quit or cut down.

3. Drinking and driving.

4. Spending too much time drinking.

5. Having hangovers or a sleep disorder.

“Alcoholism isn’t what it used to be,” Dr. Willenbring said. “What we used to know about it came from studying the very severe end of the spectrum — those with a chronic illness who reach rock bottom.”

It is now known that many people have limited episodes of alcohol dependence, and if these are recognized and dealt with early on, many alcohol-related problems can be avoided.

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Reprinted from the New York Times

"Regardless of how you try to explain to people it's a 'war on drugs' or a 'war on a product,' people see a war as a war on them," said Gil Kerlikowske, recently confirmed as the director of the Office of National Drug Control Policy (ONDCP). "We're not at war with people in this country."

Kerlikowske said that the Obama administration wants to focus on drug use as a public-health problem, with an increased emphasis on providing addiction treatment as an alternative to incarceration.

"While I don't necessarily disagree with Gil's focus on treatment and demand reduction, I don't want to see it at the expense of law enforcement," said James Pasco, executive director of the Fraternal Order of Police. "People need to understand that when they violate the law there are consequences."

The former Seattle police chief has heard from critics who question his commitment to enforcement of drug laws. Sgt. Richard O'Neill, president of the Seattle Police Officers Guild, said that a deemphasis of marijuana enforcement resulted in a open-air drug market being established in downtown Seattle. Sen. Tom Coburn (R-Okla.), the sole member of the Senate to vote against Kerlikowske's nomination, said he was concerned that the new drug czar had a permissive attitude towards marijuana.

Kerlikowske said he doesn't support legalization but is in favor of needle-exchange programs, which he said were "part of a complete public-health model for dealing with addiction."

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Reprinted with permission from JoinTogether.org.

Researchers found that approximately 7.3 million children lived with a parent who was dependent on or abused alcohol, and 2.1 million children lived with a parent who was dependent on or abused illicit drugs.

The report, Findings for Children Living with Substance-Dependent or Substance-Abusing Parents: 2002-2007 looked at children between the ages of 12 and 18 and covered the period 2002 to 2007. 



"The research increasingly shows that children growing up in homes with alcohol- and drug-abusing parents suffer -- often greatly," said SAMHSA acting administrator Eric Broderick. "The chronic emotional stress in such an environment can damage their social and emotional development and permanently impede healthy brain development, often resulting in mental and physical health problems across the lifespan. This underlines the importance of preventive interventions at the earliest possible age."

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Reprinted with permission from JoinTogether.org.

The Guardian reported April 2 that a survey by Vinexpo for Decanter Magazine showed that six out of 10 women polled said they drank at least once a week, and that most women reported drinking because they liked the taste (80 percent) or that it went well with food (70 percent).

More than 50 percent of women saw drinking wine as a "healthier" alternative to drinking beer and spirits, adding that the government's health warnings about alcohol did not deter them from drinking (less than 20 percent said they decreased consumption because of the warnings).

The results also showed that 74 percent of the women surveyed picked wines based on price. Alcohol-awareness advocates like Don Shenker, chief executive of Alcohol Concern, expressed concern about the findings. "Although the government awareness campaigns are useful, they will be ineffective as long as ministers refuse to take action such as looking at a minimum price for alcohol," Shenker said. 

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Reprinted with permission from JoinTogether.org.

Online drug-treatment programs could be as effective in the short-term as traditional in-person counseling, according to new research from Johns Hopkins and the Institute for Behavior Resources in Baltimore, the Baltimore Sun reported April 19.

Thirty-seven study participants enrolled in a methadone program were divided into two groups: a traditional counseling group and one that met via online video conferencing. Researchers reported the attendance of the online eGetGoing participants after six weeks was 90 percent, compared with 76 percent for the traditional treatment group.

"That's excellent in our treatment setting, and quite frankly in most treatment settings," said Van King, the study's lead author.

The online participants also were more likely to report that they liked the treatment program than the live-meeting participants. Researchers said that the privacy of online counseling helps to remove the stigma of drug treatment for many people with addiction problems.

The researchers acknowledged that the study did not investigate the long-term effectiveness of online treatment and said online sessions may not be practical for addicts lacking Internet access.

The study appeared in the April 2009 issue of the Journal of Substance Abuse Treatment. 

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Reprinted with permission from JoinTogether.org.

CDC researchers studied data on about 63,000 Americans and found that 17.5 percent of whites and 24.3 percent of males were binge drinkers. Of young people between the ages of 18 and 24, 27.4 percent were binge drinkers, and of people between the ages of 24-34, 24.4 percent were binge drinkers.

Binge drinking was most common among those with an income of $50,000 or more, but individuals with incomes under $25,000 annually had the highest number of binge-drinking episodes within the past 30 days.

Binge drinkers reported an average of four binge episodes a month, the CDC said, consuming an average of 8 drinks per episode. Binge drinkers who were black or American Indian/Alaskan Native averaged the highest number of binge episodes per month.

The study was published in the April 3, 2009 issue of the CDC's Morbidity and Mortality Weekly Report.

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Reprinted with permission from JoinTogether.org.

The percentage of national admissions to state-funded substance abuse treatment facilities citing methamphetamine as a primary substance of abuse decreased slightly from a recent peak of 8.2% in 2005 to 7.5% in 2007, according to recently released data from the national Treatment Episode Data Set (TEDS). These findings are consistent with other reports of declining methamphetamine use. In contrast, admissions for the primary abuse of opiates other than heroin, such as the prescription painkiller oxycodone, have increased five-fold since data collection began in 1992, reaching a high 5.0% in 2007. Admissions for the primary abuse of other drugs have remained relatively stable over the past few years.

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Reprinted with permission from CESAR.

Researchers who reviewed autopsy reports found that 21 percent of New York City bicyclists who died within three hours of their accidents had alcohol in their system. The researchers drew on data from the New York City Department of Health and Mental Hygiene regarding bicycling accidents in the city between 1996 and 2005.

Six percent of drivers involved in fatal crashes with bicycles were under the influence of alcohol.

Researcher Catherine Stayton, director of the health department's injury epidemiology unit, warned that the data was limited due to how the body metabolizes alcohol. Of 225 bicycle fatalities, only 176 victims were tested for alcohol, and of these, only 84 cases involved bicyclists who died within three hours. Tests for alcohol conducted more than three hours after the crash were not considered valid.

"It's a no-brainer to be sober when you ride in New York City," said Wiley Norvell, a spokesman for Transportation Alternatives, a transit advocacy group. "Being alert and conscious of everyone else on the road is the best protection a bicyclist has, and biking while impaired makes our already dangerous streets an even greater risk."

The data also showed that only 3 percent of bicyclists who died were wearing helmets, and that 92 percent of deaths involved a moving motor vehicle; only one of the latter accidents took place in a bicycle lane.

The study was published April 2, 2009 in the journal Traffic Injury Prevention.

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Reprinted with permission from JoinTogether.org.

AlcoholScreening.org was developed by Join Together, a project of the Boston University School of Public Health. Based on the AUDIT (Alcohol Use Disorders Identification Test), a standard in screening instruments, this simple, anonymous test takes only a few minutes and provides confidential results. AlcoholScreening.org was launched in April 2001, and the website delivered its millionth health screening on April 7, 2009. The milestone coincides with National Alcohol Awareness Month.

"Thanks for the statistics, I just thought it was 'normal'. I will try to cut down. I knew I was at risk because of my family tradition, yet I thought I was still on the safe side. I have clear data to re-evaluate my habits," wrote one user.

AlcoholScreening.org also features answers to frequently asked questions about alcohol and health consequences, and provides links to support resources and a national database of 11,000 local treatment programs. Hundreds of sites link to AlcoholScreening.org and more than fifty organizations use its syndication option to integrate AlcoholScreening.org into their own websites. Syndication also allows these sites to add local resource information.

"Consumers across the country use the Internet to get health information. It makes sense that they should use it to learn whether they may have personal health risks related to their alcohol use," said David Rosenbloom, Join Together Director. "Research shows that questions about alcohol consumption patterns, coupled with brief feedback about risk levels or referral to assessment or treatment, when appropriate, can lead individuals to reduce risky drinking over sustained periods. Reducing risky drinking patterns can prevent injuries from car crashes and other mishaps, long term illnesses, and problems with family, community members or with law enforcement."

Sponsored by the National Council on Alcoholism and Drug Dependence, Inc., (NCADD) since 1987, Alcohol Awareness Month encourages local communities to focus on alcoholism and alcohol-related issues throughout the month of April. Alcohol Awareness Month began as a way of reaching the American public with information about the disease of alcoholism -- that it is a treatable disease, not a moral weakness, and that alcoholics can and do recover.

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Reprinted with permission from JoinTogether.org.

Addiction treatment centers are seeing an influx of financial executives as the economic downturn takes a toll on personal and professional lives, Reuters reported March 24.

"We absolutely do see more people coming in naming either a job loss or huge financial reversals or big investments with Bernie Madoff," said Sigurd Ackerman, medical director at the Silver Hill Hospital rehabilitation facility in New Canaan, Conn. Ackerman said professionals were being admitted with depression, addiction problems, or both.

The financial crisis is a major factor in alcohol and other drug use according to Robert Curry, who founded Turning Point for Leaders, a coaching and consulting firm in New Canaan that creates treatment programs for senior executives. "Companies are downsizing," he said. "Budgets are being trimmed, and yet we're seeing an increase in our business."

Joseph Califano, founder of the National Center on Addiction and Substance Abuse, said that people drink more in difficult economic times, but financial institutions have not done enough to help employees cope in the past. "There's still tremendous stigma and shame," he said. "This is not a moral failing, it's a disease."

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Reprinted with permission from JoinTogether.org.

The BBC reported that for some young drinkers, the old culture of sipping a glass of wine or two at a cafe has given way to bingeing. French hospitals have reported alarming increases in the numbers of young people admitted to emergency rooms for alcohol-related problems.

"They start drinking earlier because the family is less cohesive," said Philippe Nuss, a doctor who provides addiction care at St. Antoine Hospital in Paris. "They used to be more strictly controlled by their parents but now they tend to go out and start drinking in groups from the age of about 13 to 16."

The government has responded with a plan to raise the national alcohol-purchase age from 16 to 18 and declaring some parts of Paris "dry areas" where public drinking is prohibited at night.

"We have to fight this bad habit, this growing trend for some Parisians, especially teenagers, to gather outdoors, in public, and drink for hours until they're drunk," said Patrick Bloche, mayor of Paris' 11th Arrondissement. 

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Reprinted with permission from JoinTogether.org.

The Associated Press reported March 30 that a total of 80 DEA agents will soon be working in Afghanistan, hoping to replicate their campaign against South American drug cartels in South Asia.

The overarching goal is to raise the costs of the opium trade to traffickers. The strategy is expected to include targeting drug labs and financing, and encouraging opium farmers to grow other crops.

U.S. officials say that Afghan opium is financing the insurgency and providing funds for Al Qaida terrorist cells worldwide.

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Reprinted with permission from JoinTogether.org.

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Center for Substance Abuse Research (CESAR)

It's a problem Mike Tyson knows well: fights that escalate into men biting other men. And researchers say that most human-bite cases involve males who have been drinking, the CanWest News Service reported.

Irish researchers say that 86 percent of human-bite cases involve alcohol, and that men are bitten 12 times more often than women. Most bites occur on the face -- particularly the ears, nose and cheek -- as well as the fingers and forearm. Sixty-five percent of all bites involve the ear.

"I think a lot of people wouldn't know this happens, or to the extent that it happens," said study co-author Patricia Eadie, a plastic surgeon at St. James's Hospital in Dublin. "There's a lot of person-on-person violence that can be due to alcohol and drugs." Many such incidents go unreported because victims don't seek medical attention, she added.

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Reprinted with permission from JoinTogether.org.

The magazine ranked Guzman Loera, a wanted criminal in Mexico, at number 701 on their annual list; his net worth was estimated at $1 billion. Guzman Loera escaped from prison in 2001 and now runs the Sinaloa cartel, which is partially blamed for the surge in violence near the U.S.-Mexico border. The U.S. government is offering a reward of $5 million for his capture.

Mexican officials are upset that Forbes included Guzman Loera's name on the list. "[Forbes is] comparing the deplorable activity of a criminal wanted in Mexico and abroad with that of honest businessmen," said Mexican Attorney General Eduardo Medina Mora.

"Public opinion and now even magazines not only attack and lie about the situation in Mexico, but now also praise criminals," added Mexican President Felipe Calderon. "In Mexico, it is considered a crime to praise criminals."

Forbes magazine's editor-in-chief Steve Forbes said that the magazine, which also included other criminals on the list, was just reporting a fact.

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Reprinted with permission from JoinTogether.org.

The Psychiatric Times reported that the typical addict is likely to be in their mid-30s to mid-50s, but that prevention programs often overlook Baby Boomers.

"There is a generational bias going on," said sociologist Mike Males, Ph.D., of the University of California at Santa Cruz. "Of 3,700 drug deaths in California during 2003, only 51 were [in people] under the age of 20."

The Drug Addiction Help Line reported that the typical overdose victim in 2005 was age 43, compared to 32 in 1985 and 22 in 1970. The Drug Abuse Warning Network (DAWN) reported that more than half of overdose deaths in 2003 were among 35-to-54-year-olds.

The trend toward older addicts dying holds true in Washington, D.C., said Erin Artigiani, deputy director for policy at the Center for Substance Abuse at the University of Maryland in College Park. "We don't usually see many people under 21," she said. "Mostly, it's the older users -- those with the longest history of drug use, and who are using harder drugs."

Older drug users also predominate in emergency-room visits, according to DAWN data. "I'm surprised the numbers have escaped attention this long," said Males. "How did it get to the level it did with no notice? It's really a remarkable information breakdown. These numbers are not generally picked up in the popular press. People usually look for the heart-wrenching stories, the young person who lost his or her chance at life. Emergency-room doctors and counselors are well aware of the older sector of drug users."

Dr. Males said potent prescription painkillers like the widely abused OxyContin may be contributing to overdose deaths among older Americans. Cocaine and methamphetamines also are factors, although many overdose victims had used more than one substance.

Middle-aged Americans also have been involved in more crimes nationally, a trend that may have its roots in drug addiction. 

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Reprinted with permission from JoinTogether.org.

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Center for Substance Abuse Research (CESAR)

"Addiction is a stigmatized disease that the criminal justice system often fails to view as a medical condition; as a consequence, its treatment is not as available as it is for other medical conditions," said Redonna K. Chandler, principal author of the report and chief of NIDA's Services Research Branch.

NIDA researchers stressed that the criminal-justice system is ideal for getting people into treatment and applying pressure to complete therapy. They noted that a dollar spent on drug courts, for example, saves $4 in healthcare costs, while a dollar spent on prison-based treatment saves $2-$6.

The study appears in the Jan. 14, 2009 issue of the Journal of the American Medical Association.

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Reprinted with permission from JoinTogether.org.

HealthDay News reported March 5 that even small amounts of alcohol may affect older adults more than younger adults.

The researchers tested individuals ages 50-74 and 25-35 on visual-motor coordination, planning, and the ability to move from one thought to the next, after giving them enough alcohol to reach the same blood-alcohol content.

Each person took the test twice; once 25 minutes after drinking, and again 75 minutes after drinking. The researchers found that the older adults performed worse on the first test than the younger adults, even though the older adults said they did not feel drunk.

"Older adults thought they were fine when they weren't," said researcher Sara Jo Nixon, who teaches at the University of Florida in Gainesville. "You really can't rely on asking, 'Are you alright to drive,' even with lower amounts of alcohol. This may be particularly true for older adults."

The findings were published in the March 2009 issue of the Journal of Studies on Alcohol and Drugs.

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Reprinted with permission from JoinTogether.org.

HealthDay News reported March 5 that even small amounts of alcohol may affect older adults more than younger adults.

The researchers tested individuals ages 50-74 and 25-35 on visual-motor coordination, planning, and the ability to move from one thought to the next, after giving them enough alcohol to reach the same blood-alcohol content.

Each person took the test twice; once 25 minutes after drinking, and again 75 minutes after drinking. The researchers found that the older adults performed worse on the first test than the younger adults, even though the older adults said they did not feel drunk.

"Older adults thought they were fine when they weren't," said researcher Sara Jo Nixon, who teaches at the University of Florida in Gainesville. "You really can't rely on asking, 'Are you alright to drive,' even with lower amounts of alcohol. This may be particularly true for older adults."

The findings were published in the March 2009 issue of the Journal of Studies on Alcohol and Drugs.

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Reprinted with permission from JoinTogether.org.

At least five workers at harm-reduction programs in New York and San Francisco have died of overdoses, including the founders of two needle-exchange programs. The victims included Pete Morse, 36, a 10-year veteran counselor who died in 2007 of an overdose of heroin, alcohol and cocaine, and John Watters, a researcher and advocate who fatally overdosed in 1995.

Jon Zibbell, a Skidmore College assistant professor and founder of a drug-users coalition in Massachusetts, called staff overdoses a "huge problem."

"We prevent [overdoses] among our clients," he said. "So we should try to prevent them among our workers." Program staff typically get paid little money to work in harsh environments. Training can be minimal, and some programs hire active or former drug users. Other workers may learn about drug use on the job.

Morse's family said he learned to shoot heroin only after working in harm reduction, but said he was depressed and that his workplace was not to blame for the fatal overdose. Needle-exchange supporters note that only a small percentage of workers overdose, and that overdoses also occur in abstinence-oriented programs.

Still, Kirk Read, a coworker of Morse's, said his friend's death "punctured the illusion that knowledge can protect you."

Some see the overdoses as an argument against harm reduction, while others say the cases show why more money should be put into training and supporting addiction workers.

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Reprinted with permission from JoinTogether.org.

Public support alone, however, will not be sufficient to sustain recent victories like addiction parity legislation or to meet the economic and policy challenges now facing the addiction field, said William Cope Moyers, executive director of Hazelden's Center for Public Advocacy, which conducted the survey.

The Public Attitudes Towards Addiction Survey found that more than three-quarters (79 percent) of the 1,000 adults polled called the War on Drugs a failure, and 83 percent said that first-time drug offenders should be sent to addiction-treatment programs, not prison. Moyers said the findings illustrate the disconnect between public perceptions and policymakers who "are still waging the war."

Ethan Nadelmann, director of the Drug Policy Alliance (DPA), said the Hazelden findings are in line with other research on public attitudes toward the drug war and treatment alternatives to incarceration.

Similar majorities of Americans said that addiction treatment benefits should be included in healthcare insurance plans (71 percent) and in national healthcare reform plans (77 percent). Congress last year passed legislation requiring that most health-insurance plans cover addiction and mental health services on par with other health conditions, but only if such benefits are included in their plans.

Moyers warned that the hard-earned gains of more than a decade of parity advocacy could be wiped out amid the current economic crisis and the drive for healthcare reform, despite the high levels of public support indicated by the survey findings.

He expressed particular concern that addiction treatment providers struggling with internal financial crises, such as cutbacks in public funding coupled with rising demand for services, will fail to fight the broader policy battles on issues like inclusion in healthcare reform. Hazelden plans to use the survey findings to support a new national advocacy campaign aimed at increasing public understanding of addictive diseases and increasing access to treatment.

Yet discrimination against people with addictions persists, with stigma cited as the most common negative consequence of having a family member with addiction problems.

DPA's Nadelmann said that the stubborn use of pejorative language about people with addictions noted in the survey could be traced to the continued criminalization of drug use. "Everybody generally supports the notion that treatment works, but the public still has this fundamental inconsistency in their views," he said, adding that the battle against stigma should include "both people who have problems with using drugs and people who don't have a problem."

From a policy perspective, however, Moyers said the field can't wait for the battle against stigma to be won before tackling some of the fundamental questions that will be asked of the field as healthcare reform progresses, including what constitutes treatment success and even what standard terminology should be used to define addictive diseases.

"If we don't define these things ourselves, they will be defined for us," he said.

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Reprinted with permission from JoinTogether.org.

Patients seeking psychiatric help are experiencing difficulties finding beds in suburban community hospitals with limited space in psychiatric units, and the surge in service demand is forcing more referrals to alternative facilities.

Alexian Brothers Behavioral Health Hospital in suburban Illinois has seen an increase in admissions of almost 30 percent, and was unable to accommodate 1,100 patients needing inpatient treatment this year. Brett Hall, director of intake at Alexian, said no patient is turned away without being assessed and offered a referral to another facility.

A $2-million budget deficit in Illinois has resulted in cuts to funding for mental-health services in a state that had already seen budget reductions. Some hospitals have been forced to eliminate substance-abuse programs and reduce staffing.

"It's a dangerous collision course," said Janet Stover, executive director of the Illinois Association of Rehabilitation Services. "There's not enough money and more people needing the service."

Mental Health America of Illinois said that almost 8 percent of the population suffered a severe mental illness last year. Economic concerns are forcing patients already receiving mental-health services to cut back on treatment or medication to save money.

There is no immediate solution to the crisis, officials say. "We're getting a lot more demand, and capacity going down," said Kelly Clancy, Alexian's vice president of external affairs. "We need the public and legislators to understand this is getting to a critical mass."

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Reprinted with permission from JoinTogether.org.

Researchers at the School of Social Work at the University of Illinois studied 931 women from the Chicago area who temporarily had lost child custody and were referred for alcohol and drug assessments due to chronic substance abuse.

During the five-year study, researchers randomly assigned families to either receive traditional child-welfare and substance-abuse services or traditional services plus the assistance of a recovery coach, whose focus was to place and keep mothers in treatment via hands-on engagement with the family and provider agencies.

The study showed that 15 percent of mothers assigned to the recovery-coach group had given birth to a substance-exposed infant, compared with 21 percent of mothers in the control group.

Recovery-coach group mothers also were more likely to use substance-abuse services, and were more likely to reunify their families. The researchers estimated that the state of Illinois saved $5.5 million in foster-care and other placement costs as a result of recovery-coach involvement.

"No single intervention is going to solve the complex array of problems that these families encounter," said Joseph Ryan, lead author of the study. "But if we chip away at it … it produces gains for families and for the state."

The study appeared in the November 2008 issue of the journal Child Abuse and Neglect.

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Reprinted with permission from JoinTogether.org.

While more returning U.S. soldiers struggle with addiction to painkillers prescribed by Army doctors to treat their combat injuries, the U.S. Army's approach to treating addicted soldiers is drawing increasing criticism, the Associated Press reported Jan. 21.

In the six years since the start of the war in Iraq, use of legal painkillers like Percocet, Vicodin, and OxyContin by injured troops has increased nearly 70 percent. Surveys reveal that more soldiers are struggling with prescription drug addiction and are seeking help from Army doctors and counselors.

But some critics say that the military system that historically relies on discipline as well as treatment is mishandling their charge. Barbara McDonald, a civilian social worker and Army drug abuse counselor, described the Army's handling of the recent surge in prescription drug abuse as "a terrible problem," calling the military's approach a broken system, as likely to punish or denigrate troops as to treat their addictions.

A recent court martial and subsequent imprisonment of a soldier in Fort Leonard Wood, Missouri, for illegally buying prescription drugs and selling the pills to eight other soldiers, along with allegations of misconduct and staffing shortages in the Army Substance Abuse Program (ASAP), induced Sen. Claire McCaskill, (D-Mo.) to ask the Secretary of the Army to investigate.

"Clearly, at Fort Leonard Wood and potentially across the military, they have not prioritized this as a health issue," McCaskill said. "The culture has traditionally looked at this as a discipline issue."

Army officials have defended their treatment approach, even while acknowledging treatment staffing shortages nationally; ASAP is 90 counselors short of required employment levels.

Chuck Ashbrook, who oversees ASAP prevention and education efforts at Fort Leonard Wood, said counselors pay close attention to links between substance abuse, post-traumatic stress disorder and combat injuries, noting that medical advances have allowed soldiers who might have returned from previous conflicts as casualties to survive with injuries that require stronger pain management.

Ashbrook also cited historical increases in drug dependency among soldiers during wartime. "We've always seen these kinds of problems," Ashbrook said. "This is not unique."

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Reprinted with permission from JoinTogether.org.

The Ohio legislature has voted overwhelmingly to repeal the state's so-called "UPPL Law," which allowed insurers to deny health coverage to individuals injured while under the influence of alcohol. Ohio Gov. Ted Strickland signed the measure into law on Jan. 5.

The Ohio Senate voted 32-0 in December to repeal the Uniform Individual Accident and Sickness Policy Provision Law (UPPL), followed by a 93-1 vote in the state House of Representatives. The UPPL repeal was included in a bill dealing with medical billing; the language was supported by the National Association of Insurance Commissioners and the National Conference of Insurance Legislators as well as the Ohio State Medical Association and the Ohio Hospital Association.

Advocates of addiction screening and brief intervention programs have lobbied for repeal of UPPL laws in states across the U.S., saying that the laws deter doctors from screening patients for alcohol problems out of fear that their healthcare claims will be denied. Ohio became the 15th state to repeal its UPPL language. (The other states that have repealed their UPPL exclusion are: California, Colorado, Connecticut, Illinois, Indiana, Iowa, Maryland, Nevada, North Carolina, Oregon, Rhode Island, South Dakota, Vermont and Washington.)

Ohio Department of Alcohol and Drug Addiction Services Director Angela Cornelius Dawson said the repeal "takes us, as a society, one step closer to eliminating the stigma that surrounds the disease of addiction and it will help to ensure all injured Ohioans receive timely and appropriate medical care."

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Reprinted with permission from JoinTogether.org.

Alcohol problems affect all employers, with an average of nine percent of U.S. workers drinking in ways that contribute to absenteeism, higher health care costs and lost productivity. But, researchers found that men working in hospitality and construction are approximately 50 percent more likely to have an alcohol-related problem than women in the same industry. In wholesale trade, men are almost three times more likely to have an alcohol problem than women. In addition, more than 18 percent of young workers between the ages of 18 and 25 have an alcohol-related problem, compared to just seven percent of workers 26 and older.

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Ensuring Solutions to Alcohol Problems

A brain circuit that underlies feelings of stress and anxiety shows promise as a new therapeutic target for alcoholism, according to new studies by researchers at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health (NIH). NIAAA Clinical Director Markus Heilig, M.D., Ph.D., and colleagues found that a brain molecule known as the neurokinin 1 receptor, or NK1R, appears to be a central actor in stress-related drinking.

The researchers first demonstrated that NK1R plays an integral role in alcohol consumption in animals. Mice that were genetically engineered to lack NK1 receptors consumed much less alcohol than did normal mice with fully functional NK1R. Subsequently, in a small clinical study, the researchers showed that an experimental compound designed to block NK1 receptors reduced alcohol craving and improved overall well-being among recently detoxified alcohol-dependent individuals who had high levels of anxiety.

“The driving force behind dependent individuals’ alcohol use transitions from what we call reward craving to relief craving,” explains Dr. Heilig.  “By the time people seek treatment for alcoholism, the pleasurable or rewarding effects of the drug are gone for most patients. Instead, alcohol-dependent individuals often feel low, anxious and are sensitive to stress, and they use alcohol to relieve these bad feelings.”

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National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Dr. Hill and her team imaged the brains of 107 teens and young adults using magnetic resonance imaging. They also examined variations in certain genes of the participants and administered a well-validated questionnaire to measure the youngsters' tendency to be impulsive.

"We are beginning to understand how genetic factors can lead to structural brain changes that may make people more vulnerable to alcoholism," Dr. Hill said, "leading us to conclude that they are predisposing factors in the cause of this disease, rather than a consequence of it."

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University of Pittsburgh Medical Center

"We found that intoxication-related terms reflected either moderate or heavy levels of intoxication, and that 'drunk' reflected a level of intoxication somewhere between moderate and heavy," study author Ash Levitt said. "Men tended to use heavy-intoxication words more than women, which were also relatively more forceful in their tone, such as 'hammered.' Women tended to use moderate intoxication words more than men, which were also relatively more euphemistic, such as 'tipsy.'

The researchers also found that most women ages 17-24 used the word "tipsy" to describe imbibing, on average, four drinks over two hours -- a level that meets binge-drinking criteria for females, said Levitt.

"Therefore, women could be binge drinking while psychologically perceiving their level of intoxication as being 'tipsy' or relatively benign, as opposed to heavier levels of intoxication that would be described with less euphemistic terms, such as 'hammered' or 'wasted,'" said Levitt. "Such a perception could potentially mislead women, for example, to feel as though they are capable of driving after drinking because they are 'only tipsy.'"

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Alcoholism: Clinical and Experimental Research

“This report adds to the substantial body of research indicating that participation in self-help groups can help support people battling substance abuse problems,” said SAMHSA Acting Administrator Eric Broderick, D.D.S., M.P.H.

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Substance Abuse and Mental Health Services Administration

Drinkers tested three or four days after their last drinking session exhibited more forgetfulness and absentmindedness. "We found no differences between binge drinkers and non-binge drinkers in the self-reporting questionnaires, but when it came to the video the binge drinkers recalled significantly less than the non-binge drinkers," said Heffernan. "Although from their own reports they appeared to have good memories, they didn't perform as well in the video test. The binge drinkers recalled up to a third less of the items, a significant difference."

Heffernan said research has shown that excessive alcohol use can damage parts of the brain involved in everyday memory. "Not only may these teenagers be harming their memory, if their brains are still developing they could be storing up problems for the future," he said.

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British Psychological Society

The poll of nearly 2,000 people found that heavy drinkers often lie to their partners and family about how much they drink, and that men are more likely to lie than women. The poll further suggested that 19 percent of drinkers were dishonest with themselves about their daily level of alcohol consumption.

"It's important people talk honestly if they think they may be drinking too much or even if they're not sure," said a spokesperson for the national alcohol awareness campaign Know Your Limits. "If they are drinking at higher-risk levels, their [doctor] or practice nurse will be able to advise on the health risks."

The survey suggested that government statistics on alcohol use could be misleading, said Don Shenker, CEO of the prevention group Alcohol Concern, adding that the survey "shows that the problem is far bigger than existing evidence suggests."

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Reprinted with permission from JoinTogether.org.

Researchers from the University of Manitoba find in a new study that a quarter or more of individuals with mood disorders self-medicate with alcohol and other drugs, MedWire News reported Nov. 18.

Researcher James Bolton and colleagues looked at data from the National Epidemiologic Survey on Alcohol and Related Conditions, involving 43,093 adults, and found that 24.1 percent of individuals with any mood disorder (8,420 subjects) self-medicated with alcohol or drugs. Among those suffering from bipolar disorder, self-medication was most common during depressive episodes, with 41 percent of bipolar I disorder patients and 34.7 percent of bipolar II disorder patients reporting self-medication.

Self-medication was also significantly associated with comorbid panic disorder and dependent personality disorder among men, and generalized anxiety disorder and dependent personality disorder among women. Divorced and widowed individuals also were more likely to self-medicate.

Inverse relationships between self-medication and alcohol and drug use were observed in populations 45–64 years old, greater than 65 years old, and among black, Asian, Hawaiian, and Hispanic populations.

"Clinicians should assess alcohol, drug, and prescription medication misuse in this population, as well as reasons for use, as this information may help identify a subgroup of mood-disorder patients requiring greater services," the researchers concluded.

The findings were published online Nov. 10, 2008 in the Journal of Affective Disorders. -------------

Reprinted with permission from JoinTogether.org.

British researchers say that healthcare providers should include the topic of alcohol use in their discussions with adolescents about sexual health, Reuters Health reported Nov. 18.

Researchers from the University of Sheffield and Doncaster Primary Care Trust interviewed five groups of boys and five groups of girls ages 14-16, all of whom were attending a sexual health clinic at a youth club that serves "socially deprived" populations with high rates of teen pregnancy.

The researchers presented the teens with four scenarios: a couple in which the boy but not the girl wants to have sex; a boy who is being teased by friends for not wanting to have sex with his girlfriend; a popular girl who has a reputation for having sex with multiple, older boys; and a girl who in a situation where she is pressured to have sex when two friends pair off with three boys at a sleepover.

The girls showed more empathy for the individuals involved in the scenario and did not use "negative, aggressive or coercive language" when talking about sex. The boys did use such language and talked about getting girls drunk so they would be more likely to have sex. The males also seemed to focus on how the male in the situation was thinking, not the female.

"Helping young people to approach alcohol sensibly should be a key element of sexual health promotion," said coauthors Mark Hayter and Christina Harrison, because alcohol and sex are "inextricably linked."

Counselors working with adolescents also should encourage young males to empathize with how girls feel, as well as helping young women develop the social skills necessary to resist pressure from boys and from their peers to have sex, the authors added.

The findings were published in the November 2008 issue of the Journal of Clinical Nursing.

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Reprinted with permission from JoinTogether.org.

The Betty Ford Center in Rancho Mirage, Calif., for example, now has a 90-day residential treatment program. More than 50 percent of the clients in Promises Treatment Center in Malibu are in 45- to 90-day treatment programs; the young-adult program at Promises has been extended from 30 days to 90 days.

Visions, an adolescent addiction center in Malibu, increased its program length from 30 days to 45. Hazelden also is expanding to meet the demands for treatment programs of 90 days or more.

Although 28- or 30-day treatment programs are still common, addiction experts say that longer treatment programs will help to curtail the cycle of hospitalization and relapse.

"There was a belief that 30 days was the right number," said David Sack, chief executive of Promises and an addiction psychiatrist. "But there was absolutely no data to say 30 days was the right number. What we're seeing now is this much broader view for how to manage addiction."

Recent research suggested that programs of 90 days or longer have a significant impact on relapse rates. A 1999 study published in Archives of General Psychiatry found that 35 percent of cocaine users who were in treatment for 90 days or less said they used drugs the following year, compared with 17 percent of those who were in treatment for 90 days or longer. Similarly, a UCLA study on adolescents found that those in treatment for 90 days or more had significantly lower relapse rates than teens in 21-day programs.

"The more you have a treatment that can help you become continuously abstinent, the better you do," said Lisa Onken, chief of the National Institute on Drug Abuse (NIDA) behavioral and integrative treatment branch. "You still have to figure out ways not to use," Onken added. "The longer you are able to do that, the more you are developing skills to help you stay abstinent."

Bennett Fletcher, a senior research psychologist at NIDA, said that the first month of treatment is now viewed as a preliminary step consisting of learning to cope with withdrawal symptoms while establishing a relationship with a therapist. This theory is supported by brain scans of recovering addicts which show that changes are still occurring three months or more after treatment.

The cost of longer treatment stays is out of reach for some patients, however. Although most states have laws mandating that group health insurance plans include addiction-treatment coverage, programs vary in the amount of inpatient care covered. Some plans cover 30 days of inpatient care per year; other insurers will discontinue inpatient coverage after a week or two if a patient is physically stable; some pay for treatment lasting more than 30 days. 

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Reprinted with permission from JoinTogether.org.

Smoking in the U.S. has increased due to stresses associated with rising unemployment rates, weakening retirement funds, and an overall, slowing economy, according to a new survey.

Reuters reported Nov. 10 that the American Legacy Foundation, a Washington, D.C.-based anti-smoking advocacy group, hired Harris Interactive to survey 2,375 Americans ages 18 and older about their smoking behaviors as related to the economy.

Economic stress seems to be affecting lower-income smokers (those with household incomes at $35,000 or less) and unemployed smokers the most. The survey found that more lower-income smokers said they smoked more cigarettes per day than employed smokers, and 29 percent of unemployed smokers reported increases in smoking compared to 17 percent of employed smokers.

The survey also showed that 31 percent of female smokers reported that they smoked because of economy-related worries, compared to 17 percent of men.

Anxiety related to economic troubles drove 7 percent of current smokers to begin smoking again, the survey showed, while 9 percent of previous smokers said they were tempted to resume smoking.

One-fifth of smokers who said they were stressed about the economy said they switched to a cheaper brand in an effort to save money.

"The turbulent global stock markets have caused virtually every American a certain level of stress," said American Legacy Foundation CEO Cheryl Healton. "Those who also struggle with an addiction to tobacco products are at an increased disadvantage as they contemplate quitting, or feel the urge to smoke more cigarettes."

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Reprinted with permission from JoinTogether.org.

Just days after Calif. Gov. Arnold Schwarzenegger proposed raising alcohol taxes by five cents per drink to patch up the $11.2 billion deficit in the state budget, other states are being urged to follow suit.

The San Jose Mercury News reported Nov. 7 that Schwarzenegger proposed the alcohol tax along with taxes on veterinary clinics, auto repair, and golfing fees to raise $4.7 billion in new revenue. Republicans have said they will oppose the proposal, but Schwarzenegger is still hopeful that it will pass.

"A drastic situation like this takes drastic measures," Schwarzenegger said.

Such an increase in other states could raise as much as $355 million in New York, and $430 million in Florida, according to Marin Institute, a California-based alcohol industry watchdog. "A nickel a drink -- it's the change we need to fix budgets around the nation," said Bruce Lee Livingston, executive director of Marin Institute. "The largest states, such as New York and Florida can avoid cutting essential programs through long-overdue alcohol tax increases."

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Reprinted with permission from JoinTogether.org.