Researchers at the University of Cambridge scanned the brains of 50 pairs of brothers and sisters. One in each pair was dependent on cocaine while the other did not abuse drugs or alcohol. Their brains were then compared with those of 50 unrelated healthy volunteers who had no personal or family history of drug addiction.

The researchers found that siblings shared the same abnormality in the parts of the brain associated with how we control behavior, known as the fronto-striatal systems. This kind of abnormality is typically seen in people who struggle with drug addiction, researchers note.

“It has long been known that not everyone who takes drugs becomes addicted, and that people at risk of drug dependence typically have deficits in self-control,” said Dr. Karen Ersche, of the Behavioural and Clinical Neuroscience Institute (BCNI) at the University of Cambridge.

“Our findings now shed light on why the risk of becoming addicted to drugs is increased in people with a family history of drug or alcohol dependence.

“Parts of their brains’ underlying self-control abilities work less efficiently. The use of addictive drugs, such as cocaine, further exacerbates this problem, paving the way for addiction to develop from occasional use.”

She noted it’s “intriguing” that siblings who don’t abuse drugs show similar brain abnormalities.

“While we still have more work to do to fully address the reasons why some family members show a greater resilience against addiction, our results will provide the scientific basis for the development of more effective preventative and therapeutic strategies for people at risk of addiction,” she said.

The next step will be to explore how the siblings who don’t take drugs manage to overcome their brain abnormalities in their daily lives, according to researchers. A better understanding of what may protect them from drug abuse may provide clues for developing more effective therapies for those trying to beat addiction, researchers conclude.

Source: University of Cambridge

“Research shows there is a spike in alcohol-related consequences that occur in the first few weeks of the semester, especially with college freshmen,” said Michael J. Cleveland, research associate at the university’s Prevention Research Center and the Methodology Center.

“If you can safely navigate through that passage, you reduce the risk of later problems occurring.”

The researchers tested two methods of intervention on freshmen — parent-based intervention and peer-based intervention. They found that students who were non-drinkers before starting college, and who received the parent-based intervention, were unlikely to become heavy drinkers when surveyed again during the fall semester of their first year.

Students who were heavy drinkers during the summer before college were more likely to transition out of that group if they received either parent-based intervention or peer-based intervention.

About 8 percent of the incoming freshmen were heavy drinkers the summer before starting college, Cleveland reported. The researchers surveyed the students again during the fall semester and found 28 percent of the freshmen now drank heavily.

The results of the latest study were based on a study of 1,275 high-risk college students originally conducted in 2006 by Rob Turrisi, Ph.D., a Penn State professor. Turrisi and his colleagues randomly assigned students to one of four intervention groups — parent-based intervention only, peer-based intervention only, both parent- and peer-based intervention, or no intervention — and then surveyed the students on their drinking behaviors the summer before they entered college and then again during their first fall semester.

The parent-based intervention involved parents receiving a 35-page handbook outlining how to discuss the issue of alcohol and how to relate to their college student. Parents were asked to fill out an evaluation of the booklet, which also served as a measure to determine how many parents read the material. All parents completed the evaluations.

For peer-based intervention, subjects met one-on-one with a trained peer facilitator once within the first two weeks on campus. The meetings were 45 to 60 minutes long and included “drinking consequences, alcoholic caloric consumption, and hours of exercise required to burn those calories,” the researchers report.

All students included in that survey were former high school athletes, chosen because this group is considered at high risk for heavy alcohol use and its consequences, which include risky sex, driving drunk and personal injury or death, the researchers add.

In the new investigation, Cleveland and his colleagues approached the study differently. Rather than focusing on average levels of drinking — peak blood alcohol content, drinks per weekend and drinks per week — Cleveland reanalyzed the data to determine patterns of drinking, as well as how the students responded to intervention. This allowed the researchers to examine how drinking patterns varied throughout the week, as well as how the interventions could be linked to students’ transitions from one subgroup to another.

“We found four subgroups of drinkers, which is an important advance to understanding different types of drinking that were present in this college sample,” said Cleveland.

The subgroups included non-drinkers, who did not drink at all; weekend non-bingers, who tended to only drink socially on Fridays and Saturdays; weekend bingers, who were likely to report binge drinking and getting drunk in the past month on Fridays and Saturdays; and heavy drinkers, who reported drinking every day of the week, most notably Thursdays.

Although neither intervention strategy appeared to influence the weekend drinkers, whether bingers or non-bingers, the intervention effects on the nondrinkers and heavy drinkers were promising, said Cleveland.

“From here we may be able to tailor the intervention to different types of students,” said Cleveland. “By figuring out a way to match the intervention to the individual you can also maximize your resources for intervention.”

Cleveland is continuing his work, including using the same methods to study the drinking behaviors of young adults who are not attending college.

The results of the latest research, which was supported by the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, appeared online in Psychology of Addictive Behaviors.

Source: Penn State

Friends drinking photo by shutterstock.

Scientists from Yale School of Medicine believe the findings suggest men and women with cocaine dependence might benefit from different treatment options.

In the study, investigators determined stress robustly activates areas of the brain associated with craving in cocaine-dependent women, while drug cues activate similar brain regions in cocaine-dependent men.

The study will be published in the American Journal of Psychiatry.

“There are differences in treatment outcomes for people with addictions who experience stress-induced drug cravings and those whose cravings are induced by drug cues,” said psychiatrist Dr. Marc Potenza, first author of the study. “It is important to understand the biologic mechanisms that underlie these cravings.”

The researchers conducted functional magnetic resonance imaging scans of 30 cocaine-dependent individuals and 36 control subjects who were recreational drinkers.

While undergoing brain scans, researchers then presented subjects with personalized cues (situations or events) the participants had indicated were personally stressful and other cues involving cocaine or alcohol.

Cocaine-dependent individuals presented greater activation in broad regions of the brain linked to addiction and motivation than the control subjects – a finding that was expected. But the patterns of activation between the groups differed markedly in men and women when presented with stress or drug cues.

Potenza said the findings suggest that women with cocaine dependence might benefit from stress-reduction therapies that specifically target these cravings.

Men, on the other hand, might derive more benefit from elements of cognitive behavioral therapy or 12-step programs based on the principles of Alcoholics Anonymous.

Source: Yale University

Cocaine photo by shutterstock.

Experts report that young adults often experiment with hard drugs, such as cocaine, amphetamines and opiates, and all but about 10 percent stop as they assume adult roles and responsibilities.

University of Alabama at Birmingham researchers have published their study online online in the Journal of General Internal Medicine.

The study’s lead author, Stefan Kertesz, M.D., and colleagues attempted to discover if lifelong hard-drug use shortens lifespan to better enable primary-care doctors to advise patients who use drugs recreationally.

“While government guidelines have not endorsed screening for drugs in primary care, many doctors are challenged when they discover patients continue to dabble with them,” Kertesz says.

“In primary-care practice, we often hear from stable patients who report using some cocaine, irregularly, perhaps on weekends. It’s an under-appreciated but very common situation. The typical question physicians have to ask is ‘If this patient doesn’t have an addiction, what advice can I give other than noting that it’s unwise to break the law?’ After all, we are supposed to be doctors, not law enforcement.”

Kertesz and a research team from other universities looked at data from the Coronary Artery Risk Development in Young Adults Study for their analysis, a long-term research project involving more than 5,000 black and white men and women from Birmingham, Chicago, Minneapolis and Oakland.

The research team looked specifically at the reported use of “hard drugs” by 4,301 of the participants in the study. They compared people who stopped drug use early to those who continued and calculated the likelihood of premature death among these groups.

“Fourteen percent of the people in the study reported recent hard-drug use at least once, and of these, half continued using well into middle age,” Kertesz says.

“But, most of the drug users in our study were not addicts. They were dabblers who used just a few days a month.”

Kertesz and his colleagues found that older hard-drug users were more likely to report being raised in economically challenged circumstances in a family that was unsupportive, abusive or neglectful.

The team also found that those who were heavy drug users into young adulthood and continued at lower levels into middle age were roughly five times more likely to die than persons who didn’t use drugs.

“We can’t assume that drugs caused death, as in an overdose,” he says. “Rather what we found is that middle-age adults who continue to dabble in hard drugs represent a group that is at risk of bad outcomes — which could include death from trauma, heart disease or other causes that are not a direct result of their drug use — at a higher rate than people who stopped using drugs.”

Kertesz and his team believe the findings show people who continue to use drugs are potentially quite vulnerable. Researchers believe these individuals have often grown up under economic and psychosocial stress from childhood onward.

Perhaps as a method to relieve stress or self-medicate for depression, individuals continue to smoke and drink and they remain at elevated risk of premature death.

“Based on the data we hope to offer better advice to primary-care doctors struggling with the rising tide of drug-taking by adults who have not left behind many of the bad habits they learned in young adulthood,” he says.

Source: University of Alabama at Birmingham

Man snorting drugs photo by shutterstock.

Researchers from The City College of New York followed smokers from different socioeconomic backgrounds after they had completed a statewide smoking cessation program in Arkansas.

After a program of cognitive-behavioral therapy, either with or without nicotine patches, underprivileged and those from higher social economic backgrounds were able to quit at about the same rate.

However, as time progressed, a significant number of the underprivileged returned to smoking. Those with the fewest social and financial resources had the hardest time staving off cravings over the long run.

“The poorer they are, the worse it gets,” said clinical psychologist Christine Sheffer, Ph.D., who directed the program.

Shaffer discovered smokers on the lowest rungs of the socioeconomic ladder were 55 percent more likely than those at the upper end to start smoking again three months after treatment.

By six months post-quitting, the probability of their going back to cigarettes jumped to 2-1/2 times that of the more affluent smokers.

The research will be published in the March issue of the American Journal of Public Health and will appear online under the journal’s “First Look” section.

As part of the study, Sheffer and her colleagues noted that overall, Americans with household incomes of $15,000 or less smoke at nearly three times the rate of those with incomes of $50,000 or greater.

Smoking is still the greatest cause of preventable death and disease in the U.S. today, noted Sheffer. “And it’s a growing problem in developing countries.”

Sheffer believes there are several reasons why it may be harder for some to give up tobacco permanently. Stress is a common reason for nicotine addiction. Unfortunately, those on the lower end of the socioeconomic scale suffer more hardships than those at the top, in the form of financial difficulties, discrimination, and job insecurity, to name a few.

And for those smokers who started as teenagers, they may have never learned other ways to manage stress, Sheffer said.

For people with lower socioeconomic status (SES), it can be tougher to avoid temptation as well.

“Lower SES groups, with lower paying jobs, aren’t as protected by smoke-free laws,” said Sheffer, so individuals who have quit can find themselves back at work and surrounded by smokers. Also, fewer of them have no-smoking policies in their homes.

Unfortunately these real-world circumstances are rarely addressed in standard treatment programs.

“The evidence-based treatments that are around have been developed for middle-class patients,” Sheffer pointed out. “So (in therapy) we talk about middle-class problems.”

Additional research will help determine how the standard six sessions of therapy may be augmented to address various clients.

“Our next plan is to take the results of this and other studies and apply what we learned to revise the approach, in order to better meet the needs of poor folks,” says Sheffer. “Maybe there is a better arrangement, like giving ‘booster sessions’. Not everybody can predict in six weeks all the stresses they will have later on down the road.

“Some people say [quitting] is the most difficult thing in their life to do,” she said. “If we better prepare people with more limited resources to manage the types of stress they have in their lives, we’d get better results. “

Source: The City College of New York

The University of Pittsburgh study compared the brain activity of adolescent and adult rats involved in a task in which they anticipated a reward.

The researchers found increased brain cell activity in an area of the brain called the dorsal striatum (DS) — a site commonly associated with habit formation, decision-making, and motivated learning.

However, when adult rats were exposed to the situation, this area of the adult rat brain did not become activated by an anticipated reward.

“The brain region traditionally associated with reward and motivation, called the nucleus accumbens, was activated similarly in adults and adolescents,” said Bita Moghaddam, Ph.D., a coauthor of the paper. “But the unique sensitivity of adolescent DS to reward anticipation indicates that, in this age group, reward can tap directly into a brain region that is critical for learning and habit formation.”

Rather than studying the difference or similarities between the behaviors of adolescents and adults, researchers studied brain actions to see if similar activities were present among the two groups.

The researchers’ predictions proved accurate. Even though the behavior was the same for both adult and adolescent rats, the researchers observed age-related neural response differences that were especially dramatic in the DS during reward anticipation.

This shows that not only is reward expectancy processed differently in an adolescent brain, but also it can affect brain regions directly responsible for decision-making and action selection.

“Adolescence is a time when the symptoms of most mental illnesses—such as schizophrenia and bipolar and eating disorders—are first manifested, so we believe that this is a critical period for preventing these illnesses,” Moghaddam said.

“A better understanding of how the adolescent brain processes reward and decision-making is critical for understanding the basis of these vulnerabilities and designing prevention strategies.”

Researchers state that future research will continue to compare adolescent and adult behavior, especially as it relates to stimulants—such as amphetamines—and their influence on brain activity.

Researchers published a paper on their findings in the Proceedings of the National Academy of Sciences.

Source: University of Pittsburgh

Researchers at the Ernest Gallo Clinic and Research Center at the University of California, San Francisco, report this is the first time that the endorphin release in the nucleus accumbens and orbitofrontal cortex has been directly observed in humans.

“This is something that we’ve speculated about for 30 years, based on animal studies, but haven’t observed in humans until now,” said lead author Jennifer Mitchell, Ph.D., clinical project director at the Gallo Center and an adjunct assistant professor of neurology at UCSF. “It provides the first direct evidence of how alcohol makes people feel good.”

Discovering the precise locations in the brain where endorphins are released provides possible targets for developing more effective drugs for the treatment of alcohol abuse, said senior author Howard L. Fields, M.D., Ph.D., a professor of neurology and Endowed Chair in Pharmacology of Addiction in Neurology at UCSF and director of human clinical research at the Gallo Center.

The researchers used positron emission tomography, or PET imaging, to observe the immediate effects of alcohol in the brains of 13 heavy drinkers and 12 control subjects who were not heavy drinkers. In all of the subjects, alcohol intake led to a release of endorphins — and the more endorphins that were released in the nucleus accumbens, the greater the feelings of pleasure reported by each drinker.

The heavy drinkers also reported greater feelings of intoxication with more endorphins released in the orbitofrontal cortex, but the control subjects did not, the researchers noted.

“This indicates that the brains of heavy or problem drinkers are changed in a way that makes them more likely to find alcohol pleasant, and may be a clue to how problem drinking develops in the first place,” said Mitchell. “That greater feeling of reward might cause them to drink too much.”

Before drinking, the subjects were given injections of radioactively tagged carfentanil, an opiate-like drug that binds to sites in the brain called opioid receptors, where endorphins also bind. As the radioactive carfentanil was bound and emitted radiation, the receptor sites “lit up” on PET imaging, allowing the researchers to map their exact locations.

The subjects were then each given a drink of alcohol, followed by a second injection of radioactive carfentanil, and scanned again with PET imaging. By comparing areas of radioactivity in the first and second PET images, the researchers were able to map the exact locations where endorphins were released in response to drinking.

The researchers found that endorphins released in response to drinking bind to a specific type of opioid receptor, the Mu receptor.

This suggests a possible approach to improving the treatment for alcohol abuse through the design of better medications than naltrexone, said Fields, who explained that naltrexone prevents binding at opioid receptor sites. While effective in reducing drinking, the drug is not widely accepted as a treatment for alcohol dependence — “because some people stop taking it because they don’t like the way it makes them feel,” he said.

“Naltrexone blocks more than one opioid receptor, and we need to know which blocking action reduces drinking and which causes the unwanted side effects,” he said. “If we better understand how endorphins control drinking, we will have a better chance of creating more targeted therapies for substance addiction.”

The study appears in Science Translational Medicine.

Source: University of California, San Francisco

More than 38 million adults binge drink, CDC officials said, defining binge drinking as having four or more drinks for women and five or more for men over a short period of time.

On average, the drinkers go on binges about four times a month, while the largest number of drinks consumed is eight, according to a report in the agency’s publication Vital Signs.

The report found that people who were thought less likely to binge drink actually do it more often and consume more drinks. While binge drinking is more common among young adults, aged 18-34 years, binge drinkers over the age of 65 years report binge drinking more often — an average of five to six times a month.

And while binge drinking is more common among people with household incomes of $75,000 or more, the largest number of drinks consumed on one occasion is significantly higher among binge drinkers with household incomes less than $25,000 — an average of eight to nine drinks, far beyond the amount thought to induce intoxication, CDC officials said.

Binge drinking is most common in the Midwest, New England, the District of Columbia, Alaska, and Hawaii, the report continues. The number of drinks consumed during a binge is highest in the Midwest and southern Mountain states (Arizona, Nevada, New Mexico, and Utah), and in some states — such as Louisiana, Mississippi, and South Carolina —where binge drinking is less common.

The CDC report notes that binge drinking is a “dangerous and costly public health problem.”

Facts delineated in the report include:

• Most alcohol-impaired drivers binge drink;
• Most people who binge drink are not alcohol dependent or alcoholics;
• More than half of the alcohol adults drink is during a binge;
• More than 90 percent of the alcohol kids drink is during a binge;
• Drinking too much, including binge drinking, causes more than 80,000 deaths in the United States each year;
• Drinking too much cost the United States $223.5 billion in 2006, or $1.90 a drink, from losses in productivity, health care, crime, and other expenses;
• Binge drinking cost federal, state, and local governments about 62 cents per drink in 2006, while federal and state income from taxes on alcohol totaled only about 12 cents per drink;
• Drinking too much contributes to more than 54 different injuries and diseases, including car crashes, violence, and sexually transmitted diseases. Over time, binge drinking also can lead to liver disease, certain cancers, heart disease, stroke, and many other chronic health problems.

Source: Centers for Disease Control and Prevention

The Rhode Island Hospital study, available online in the journal Addiction, has important implications as over 700,000 inmates leave prisons each year and over two-thirds of those inmates have a drug problem.

Experts caution that the return of inmates to the community is a critical issue for public health and safety. Moreover, the economic impact of incarceration and re-incarceration, including inmate medical and mental health costs, are issues that states and communities can no longer absorb.

Currently, relapse following release contributes to the re-arrest of more than two-thirds of parolees and re-incarceration of over half of inmates in the three years after release.

While treatment can reduce relapse, drug-involved ex-inmates are given limited priority to addiction treatment. Surveillance with the threat of sanction by parole officers is the traditional method of following parolees, yet many ex-offenders fall into the same pattern and are arrested again.

Building on the success of contingency management (a strategy that rewards desired behavior and may punish undesirable behavior) researchers, led by Peter D. Friedmann, M.D., performed a clinical trial called “Step ‘n Out” to determine whether collaborative behavioral management would be effective in reducing substance abuse, crime and re-arrest among drug-involved parolees.

Friedmann explains, “Because of the so-called ‘War on Drugs,’ an unprecedented number of people have been put in prison for drug use and the great majority of them return to the community. Community reentry is a difficult period – having a criminal record makes it hard to get a job and you usually return to the same environment you came from with the same people and temptations. Thus, a large proportion of drug-involved ex-offenders return to drugs and crime.”

Addiction treatment during the transition period can reduce relapse, but competing priorities such as the need for housing and finding work often limit ex-offenders’ willingness to participate in treatment.

Parole and probation are supposed to encourage treatment and prevent a return to drugs and crime, but they are poorly designed to do so. Probation and parole are based on supervision and punishment for bad behavior. For example, if a parolee tests positive for drugs, he/she might be returned to jail.

Behavioral theory holds that effective reinforcers or punishments must be both immediate (close in time to the behavior) and reliable (happen every time the behavior happens).

“Any parent knows that punishment alone is not the optimal way to motivate behavior – it is best to have both carrots and sticks,” Friedmann says.

“The problem is that punishment is neither immediate nor reliable — in part because of due process, but also because surveillance is imperfect and offenders have a disincentive to get caught. Conversely, drug use produces both immediate and reliable reinforcement, where a user gets a good feeling with every use.”

Friedmann explains, “The everyday reinforcers of daily life such as a good job and good family life can’t compete – they are delayed and not guaranteed.” Thus, behavioral theory explains what we see – the reentry period is extremely challenging and many ex-offenders end up returning to drugs and crime.”

Through the Step’n Out study, the researchers developed a system of “bridge reinforcement” to provide incentives for good behavior.

Weekly over 12 weeks, officers, treatment counselors and clients worked together to agree on a behavioral contract in which there were three target behaviors.

If the client met the behaviors then they were rewarded through a system of points that led to positive social reinforcers or material reinforcers like gift cards. A computer program helped track and manage the points and reinforcers.

The motto of the study was “Catching People Doing Things Right” because the clients now had a reason to report their successes and the parole officers to recognize them. This intervention was studied in a randomized clinical trial in six parole offices in five states.

The Step ‘n Out trial reported that collaborative behavioral management worked to reduce primary drug use among “non-hard drug” users, primarily marijuana.

Since marijuana users comprise a large proportion of individuals arrested for drug use, this study suggests that this behavioral approach to community corrections might reduce drug use and ultimately reincarceration. The findings, however, could not demonstrate benefit among parolees who preferred stimulants or opiates.

Friedmann notes, “Since the majority of drug violation arrests in the U.S. are for marijuana, these findings have important implications for the management of a substantial proportion of parolees. The study shows that an intervention grounded in behavioral science is feasible and effective in real-world correctional settings.”

Source: Lifespan

Unfortunately, anti-smoking campaigns neglect this effect, says NWO-funded researcher Zeena Harakeh.

Harakeh, a social scientist from Utrecht University, sought to determine what persuades young smokers to light up a cigarette. Her research showed that this group ultimately smokes more cigarettes when they see other young smokers.

“I call this implicit, passive influencing, as it happens without the other person actively offering a cigarette,” explains Harakeh.

Interestingly, young smokers who communicate with a peer online and see this person smoking will smoke more themselves.  “So the effect is there even when they do not smell the cigarette scent of the other,” says Harakeh.

Harakeh notes that in anti-smoking campaigns young people are mostly warned about the explicit, active influence.  However, her research reveals that actively offering young smokers a cigarette had less effect than was previously thought.

“It would seem that young people find it easier resist the temptation of a peer offering a cigarette than a peer who is smoking,” says Harakeh.   “Prevention programs completely ignore the passive, implicit influence. More attention should be paid to that.”

Harakeh suggests that young smokers no longer be shown in anti-smoking campaigns. “Merely the image of a young smoker might well cause another young person to light up a cigarette,” she says.

The research is published online in the scientific journals Nicotine and Tobacco Research and Drug and Alcohol Dependence.

Source:  The Netherlands Organisation for Scientific Research

A clinical trial at the University at Buffalo Roswell Park Cancer Institute (RPCI) found that smokers who took the medication varenicline, marketed as Chantix, for four weeks before they actually tried to quit smoking achieved more success than those who took the medication for just one week before quitting, which is the standard treatment.

The study, recently published in Clinical Pharmacology and Therapeutics, focused on 35 women and 25 men from Western New York who smoked a pack of cigarettes a day.

“Varenicline was designed to make smoking less rewarding, and our data suggests that it does that better when people take it for a few extra weeks before quitting,” says Larry W. Hawk, Jr., PhD, lead author and associate professor of psychology in the University of Buffalo College of Arts and Sciences.

“If this finding holds up in larger studies, it could have a major impact on public health.”

“We saw nearly full compliance, which suggests that this is not only a well-tolerated therapy, but one people can realistically stick with,” adds co-author Martin C. Mahoney, MD, PhD, associate professor of oncology in RPCI’s Departments of Medicine and Health Behavior.

Mahoney notes that many of the study participants reported mild nausea — which may have helped reduce the desire to smoke. The nausea typically goes away after a few weeks, he adds.

“Whether through changes in taste or nausea, it seems this extra varenicline reduces smoking rates before people try to quit,” Hawk says. “These changes should make it easier to quit smoking, but we also know that it takes some period of time for this new learning to occur. That’s why we decided to see if a longer period of treatment with varenicline before smokers tried to quit would result in better outcomes, and it did in this small study.”

The researchers also found that women who took varenicline for four weeks were more likely to reduce their smoking, possibly because they reported more nausea. After three weeks of treatments with varenicline, women reduced their smoking by more than 50 percent, on average.

The men who took the varenicline for four weeks reduced their smoking by 26 percent. The researchers say that much larger studies are needed to tell whether the gender differences are real.

“This study suggests we may be able to take the most effective smoking-cessation treatment we have and make it work 50 percent better, just by giving the medication for a few weeks before smokers attempt to quit,” concludes Hawk.

Source: University at Buffalo

The study, conducted by researchers at Columbia University’s Mailman School of Public Health and the University of British Columbia, notes that while further investigation is needed to determine the link between injecting methamphetamine and suicidal behavior, researchers theorize it probably involves a combination of neurobiological, social, and structural mechanisms.

“Compared to other injection drug users, it is possible that methamphetamine users are more isolated and have poorer social support systems,” said lead author Brandon Marshall, PhD, a postdoctoral fellow at the Mailman School of Public Health and research coordinator for the Urban Health Research Initiative in British Columbia. “The high rate of attempted suicide observed in this study suggests that suicide prevention efforts should be an integral part of substance abuse treatment programs. In addition, people who inject methamphetamine but are not in treatment would likely benefit from improved suicide risk assessment and other mental health support services within health care settings.”

The Vancouver Injection Drug Users Study is part of the ongoing British Columbia Centre for Excellence in HIV/AIDS’ Urban Health Research Initiative, which focuses on the effects of substance use, infectious diseases, and the environment on the health of urban populations. Researchers note that Vancouver’s Downtown Eastside is known as a center for illicit drug use, and fatalities from drug overdoses and drug-related violence are common.

Participation in the seven-year study, which ended in May 2008, was through word of mouth, street outreach, and referrals. The study included an interviewer-administered questionnaire on sociodemographic characteristics, drug use, treatment utilization, and HIV risk behaviors. The researchers evaluated 1,873 participants whose median age was 31. About 36 percent of participants were female and 32.1 percent were of Aboriginal ancestry. About 8 percent of study participants reported a suicide attempt.

The researchers also discovered that infrequent methamphetamine injection was a predictor of attempting suicide, while frequent methamphetamine injection was associated with the greatest risk of attempting suicide.

The study, published in the December issue of Drug and Alcohol Dependence, was funded by the National Institutes of Health and the Canadian Institutes of Health Research.

Source: Columbia University Mailman School of Public Health

“People who focus on the here and now, without thinking about the impact on the future, are more aggressive than others when they are sober, but the effect is magnified greatly when they’re drunk,” said Brad Bushman, Ph.D., lead author of the study and a professor of communication and psychology at The Ohio State University.

“If you carefully consider the consequences of your actions, it is unlikely getting drunk is going to make you any more aggressive than you usually are.”

Bushman said it makes sense that alcohol would make these people more aggressive.

“Alcohol has a myopic effect — it narrows your attention to what is important to you right now,” he said. “That may be dangerous to someone who already has that tendency to ignore the future consequences of their actions and who is placed in a hostile situation.”

Dr. Peter Giancola, a professor of psychology at the University of Kentucky, co-authored the paper with Bushman and led the experiments used in the study.

The study involved 495 adults, with an average age of 23, who were social drinkers. Before participating, the participants were screened for any past or present drug, alcohol and psychiatric-related problems. Women were tested to ensure they weren’t pregnant.

All participants completed a measure of how much the person considers future consequences when thinking about current behavior. They indicated how much they agreed with statements like “I only act to satisfy immediate concerns, figuring the future will take care of itself.” Scores on this measure determined how much participants were present-focused or future-focused.

Men were more aggressive than women overall, but the effects of alcohol and personality were similar in both sexes. In other words, women who were present-focused were still much more aggressive when drunk than were women who were future-focused, just like men.

Half the participants were put in the alcohol group, where they received alcohol mixed with orange juice at a 1:5 ratio. The other half were given orange juice with just a tiny bit of alcohol. The rims of the glasses were also sprayed with alcohol so that they thought they were consuming a full alcoholic beverage.

Participants in the alcohol group had a mean blood alcohol level of 0.095 just before aggression was measured and 0.105 following, meaning they were legally drunk and that their alcohol levels were rising during the measurement of their aggressive behavior.

Those in the placebo group had mean blood alcohol levels that didn’t exceed 0.015, meaning they had very little alcohol in their systems and were well below standards of intoxication.

The aggression measure used in this study was developed in 1967 to test aggressiveness through the use of harmless but somewhat painful electric shocks. The researchers measured the participants’ threshold to the electric shock pain before the experiment began to ensure that no one received a shock that exceeded what they could take.

Each of the participants was told that he or she was competing with a same-sex opponent in a computer-based speed reaction test, with the winner delivering an electrical shock to the loser. The winner determined the intensity and the length of the shock delivered to the loser.

But there was actually no opponent, researchers said. There were 34 trials, and the participant “won” half of them (randomly determined). Each time they “lost,” the participants received electric shocks that increased in length and intensity over the course of the trials, and the researchers measured if they retaliated in kind.

“The participants were led to believe they were dealing with a real jerk who got more and more nasty as the experiment continued,” Bushman said. “We tried to mimic what happens in real life, in that the aggression escalated as time went on.”

Results were clear, Bushman said. “The less people thought about the future, the more likely they were to retaliate, but especially when they were drunk,” he said. “People who were present-focused and drunk shocked their opponents longer and harder than anyone else in the study. Alcohol didn’t have much effect on the aggressiveness of people who were future-focused.”

Bushman said the results should serve as a warning to people who live only in the moment without thinking too much about the future.

“If you’re that kind of person, you really should watch your drinking,” he said. “Combining alcohol with a focus on the present can be a recipe for disaster.”

Their results appear online in the Journal of Experimental Social Psychology and will be published in a future print edition.

Source: The Ohio State University

Man drinking photo by shutterstock.

The study is published online in the American College of Obstetricians and Gynecologists’ journal, Obstetrics & Gynecology.

The program takes an early intervention approach to improve maternal health and reduce health care expenditure. The cost-benefit analysis of the Kaiser Permanente Early Start program follows a 2008 Kaiser Permanente study that showed the program helps pregnant women at risk of substance abuse achieve similar health outcomes — for both mothers and their infants — as women who do not use cigarettes, alcohol or drugs.

The program decreases maternal and neonatal morbidity and stillbirths, said the study’s lead author Nancy C. Goler, M.D.

“Now, we’re able to show everyone that not only is it the right thing to do, we will save money,” Goler said. “This program is a very low-technology intervention that has an enormous net cost savings.”

The program involves screening pregnant women by urine toxicology tests and substance-abuse screening questionnaires.

In the study, researchers examined 49,261 women and, comparing the health care costs for pregnant women in four groups, found the Early Start program yields an average net cost benefit of $5.9 million annually.

One group of women at risk for substance abuse in pregnancy participated in full Early Start services, including a one-hour psychosocial assessment and follow-up appointments. The second group of women at risk for substance abuse had limited Early Start services, including a one-hour psychosocial assessment without follow-up.

The third group of women at risk for substance abuse did not access Early Start, and the women in the control group tested negative for substance use in pregnancy and were not at risk.

Researchers believe nearly $2 billion could be saved for every 4 million births each year if the program was implemented nationwide, the study estimated.

Experts believe a critical factor toward Early Start’s success is the program’s accessibility to patients. The program is located at the same clinic in which pregnant women receive their routine prenatal care, Goler said, adding that appointments with the woman’s prenatal care provider and her Early Start specialist are coordinated.

More clinicians should move their substance-abuse prevention programs for pregnant women into prenatal care sites, Goler noted.

Source: Kaiser Permanente

In a commentary in the journal Annals of Internal Medicine, investigators describe the probable contribution of Internet pharmacies to the problem and outline potential strategies for addressing it.

Experts say awareness and new policies to combat the trade are critical to halt the growing abuse of prescription drugs. Measures are necessary to address the availability of these drugs on the Internet and increase physician awareness of the dangers posed by Internet pharmacies.

“Controlled prescription drugs like Oxycontin, Xanax, and Ritalin are easily purchased over the Internet without a prescription, yet physician awareness of this problem is low,” says Anupam B. Jena, M.D., Ph.D., lead author of the article.

“Abuse of medications purchased from websites can pose unique challenges to physicians because patients who abuse these medications may not fit clinical stereotypes of drug abusers.”

The authors note that abuse of controlled prescription drugs now exceeds abuse of all illegal drugs combined, except marijuana. In November, the U.S. Centers for Disease Control and Prevention reported that the death toll from overdoses of prescription painkillers such as Oxycontin has more than tripled in the past decade.

Some illegitimate online pharmacies sell drugs with no prescription or medical information at all while others ask for completion of a questionnaire before a prescription is issued by a physician who has never seen the patient.

Studies from have found that 85 percent of websites offering controlled prescription drugs do not require a prescription, and many that do allow the prescription to be faxed, increasing the risk of forgery or fraud.

“The Internet serves as an open channel for distribution of controlled prescription drugs with no mechanisms to even block sales to children. This is particularly dangerous given that addiction is a disease that, in most cases, originates with substance use in adolescence,” said Susan Foster, M.S.W., of the National Center on Addiction and Substance Abuse at Columbia University, which contributed to the commentary.

Additional investigations by U.S. agencies have verified the ease with which controlled drugs can be purchased online, but little information is available on how drugs acquired that way are used.

While some surveys suggest that as many as 10 percent of prescription drug abusers obtain their drugs online, the authors stress that such surveys probably underestimate the situation and would not reach individuals most likely to abuse prescription drugs purchased over the Internet.

They also note that surveys in drug treatment centers would totally miss local drug dealers, who are increasingly likely to access their supplies online.

Earlier this year Jena and Dana Goldman, Ph.D., director of the Schaeffer Center at USC and a co-author of the commentary, published a study finding that states with the greatest expansion in high-speed Internet access from 2000 to 2007 also had the largest increase in admissions for treatment of prescription drug abuse.

They estimated that for every 10 percent increase in high-speed Internet use during those years, admissions for prescription drug abuse increased 1 percent.

“Prescription use starts with the physician,” said Goldman, “and we need to more actively engage them to control illicit use. Access to universal, electronic prescription records would be of great assistance in this regard.”

Both federal and private agencies have taken measures to reduce the impact of illicit Internet pharmacies, including the 2008 passage of the Ryan Height Online Pharmacy Consumer Protection Act, which specifically prohibits delivery of controlled substances prescribed by a physician who had never examined the patient.

But it is not know whether that law and related efforts, such as FDA warning letters to Internet pharmacies and their service providers, are at all successful. The authors note that regulatory efforts also are “stymied by these pharmacies’ ability to appear, disappear, and reappear constantly,” and the reluctance of search engines to stop running ads for rogue online pharmacies.

The increasing online availability of prescription drugs may entice individuals believed to be at low risk for drug abuse to overuse controlled medications.

The authors note that, while physicians and other health care providers should play a major part in addressing the challenges posed by Internet pharmacies, their awareness of the problem and ability to recognize and treat substance abuse of any kind is usually limited.

“Physicians need to educate patients about the risks of purchasing any medications over the Internet and should consider brief but routine questioning about Internet-based medication use,” said Jena. “Given the ability of illegal online pharmacies to evade law enforcement efforts, physician awareness and involvement will be crucial to reducing this problem.”

Source: Massachusetts General Hospital

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