Laboratories that perform pre-employment drug screening are fighting back - against hundreds of products now on the market that promise to mask evidence of illicit drug use, according to an article scheduled for the Sept. 8 issue of Chemical & Engineering News, ACS' weekly news magazine.
In the article, C&EN Senior Business Editor Melody Voith points out that job applicants now have access to an array of products purported to alter urine samples to hide evidence of marijuana, cocaine, and other illegal drugs. Some are supposed to dilute evidence of illicit drugs to levels undetectable by conventional tests. Others used adulterants advertised to inactivate or destroy chemical markers used to identify drugs.
Drug-testers are responding with more sensitive tests that can identify tell-tale chemical signs of diluted urine samples or quickly detect the presence of adulterants. The article also explains that testers may get a boost from proposed new drug testing guidelines from the U.S. Department of Health & Human Services. They would permit use of hair and saliva samples in drug screening of candidates for federal jobs. That screening could indentify illicit drugs more reliably than urine samples alone, the article notes.
"Catching a Cheater"
Click here to view article online.
American Chemical Society
вторник, 26 апреля 2011 г.
Single Question Can Identify Unhealthy Alcohol Use In Patients
Researchers at Boston Medical Center (BMC) have found that a single-screening question recommended by the National Institute of Alcohol Abuse and Alcoholism (NIAAA) accurately identifies unhealthy alcohol use in primary-care patients. This research supports the use of the brief screen in the primary-care setting. The BMC study appears online in the Journal of General Internal Medicine.
Unhealthy alcohol use, the spectrum from risky consumption to alcohol use disorders, alcohol abuse and dependence, is prevalent but under-diagnosed in primary-care settings. Commonly used alcohol screening instruments are comprised of multiple questions, often do not cover the full spectrum of unhealthy use, and can be time consuming to administer. Consequently, many patients are not screened.
The NIAAA recommends a single-question screen for unhealthy alcohol use. The recommended question asks, "How many times in the past year have you had X or more drinks in a day?" (where X is 5 for men and 4 for women). While similar single-question screens have been validated in various settings, the NIAAA recommended screening test had not been validated in the primary-care setting. BMC researchers attempted to validate this version of the screening question in a sample of primary-care patients.
Of the 286 study participants reviewed, unhealthy alcohol use was reported by 31 percent of participants. Six percent consumed risky amounts but did not have alcohol-related problems or a disorder, 13 percent consumed risky amounts and had problems but no current disorder and 12 percent had a current alcohol use disorder. The single-question screen was 81.8 percent sensitive and 79.3 percent specific for the detection of unhealthy alcohol use. It was slightly more sensitive and less specific for the detection of a current alcohol use disorder.
"The single-question screening recommended by the NIAAA appears to have favorable characteristics," said lead author Peter Smith, MD, attending physician in the section of General Internal Medicine at Boston Medical Center. "Single-question screening tests for unhealthy alcohol use may help to increase the frequency of screening in primary-care."
Researchers further state that screening and brief intervention by primary-care physicians for those with unhealthy alcohol use reduces risky consumption among those without dependence and improves patient outcomes.
Notes:
This study was funded by the National Institute of Alcohol Abuse and Alcoholism. The National Institute of Alcohol Abuse and Alcoholism had no role in the design and conduct of the study, the collection, management, analysis and interpretation of the data, or the preparation, review and approval of the manuscript.
For more information on Boston Medical Center, please visit bmc/.
Source: Michelle Roberts
Boston University
Unhealthy alcohol use, the spectrum from risky consumption to alcohol use disorders, alcohol abuse and dependence, is prevalent but under-diagnosed in primary-care settings. Commonly used alcohol screening instruments are comprised of multiple questions, often do not cover the full spectrum of unhealthy use, and can be time consuming to administer. Consequently, many patients are not screened.
The NIAAA recommends a single-question screen for unhealthy alcohol use. The recommended question asks, "How many times in the past year have you had X or more drinks in a day?" (where X is 5 for men and 4 for women). While similar single-question screens have been validated in various settings, the NIAAA recommended screening test had not been validated in the primary-care setting. BMC researchers attempted to validate this version of the screening question in a sample of primary-care patients.
Of the 286 study participants reviewed, unhealthy alcohol use was reported by 31 percent of participants. Six percent consumed risky amounts but did not have alcohol-related problems or a disorder, 13 percent consumed risky amounts and had problems but no current disorder and 12 percent had a current alcohol use disorder. The single-question screen was 81.8 percent sensitive and 79.3 percent specific for the detection of unhealthy alcohol use. It was slightly more sensitive and less specific for the detection of a current alcohol use disorder.
"The single-question screening recommended by the NIAAA appears to have favorable characteristics," said lead author Peter Smith, MD, attending physician in the section of General Internal Medicine at Boston Medical Center. "Single-question screening tests for unhealthy alcohol use may help to increase the frequency of screening in primary-care."
Researchers further state that screening and brief intervention by primary-care physicians for those with unhealthy alcohol use reduces risky consumption among those without dependence and improves patient outcomes.
Notes:
This study was funded by the National Institute of Alcohol Abuse and Alcoholism. The National Institute of Alcohol Abuse and Alcoholism had no role in the design and conduct of the study, the collection, management, analysis and interpretation of the data, or the preparation, review and approval of the manuscript.
For more information on Boston Medical Center, please visit bmc/.
Source: Michelle Roberts
Boston University
LSUHSC Awarded $4 Million To Understand Effect Of THC On HIV
Patricia Molina, MD, PhD, Professor and Head of Physiology at LSU Health Sciences Center New Orleans, has been awarded a $4 million grant over five years by the National Institute on Drug Abuse of the National Institutes of Health to study how cannabinoids, the principal psychoactive component of marijuana, produce subtle changes in gene activity that affect how a person responds to HIV infection.
As the grant's principal investigator, Dr. Molina will lead a team of geneticists, microbiologists, pharmacologists, and physiologists to explore the mechanisms involved in the anti-inflammatory effects and suppression of viral replication associated with prolonged survival in a model of HIV. The hypothesis will be tested with the following specific aims:
Demonstrate that chronic cannabinoid treatment decreases tissue inflammation
Identify the mechanisms of cannabinoid-induced suppression of inflammation
Examine the direct and indirect mechanisms by which cannabinoids decrease viral replication
While the ability of cannabinoids to suppress inflammation and viral replication has been reported by others and confirmed by ongoing studies in Dr. Molina's lab, the mechanisms involved are not known.
"The expected results will have a profound impact on the potential development of targeted therapeutic interventions to ameliorate HIV disease progression," notes Dr. Molina.
Source:
Leslie Capo
Louisiana State University Health Sciences Center
As the grant's principal investigator, Dr. Molina will lead a team of geneticists, microbiologists, pharmacologists, and physiologists to explore the mechanisms involved in the anti-inflammatory effects and suppression of viral replication associated with prolonged survival in a model of HIV. The hypothesis will be tested with the following specific aims:
Demonstrate that chronic cannabinoid treatment decreases tissue inflammation
Identify the mechanisms of cannabinoid-induced suppression of inflammation
Examine the direct and indirect mechanisms by which cannabinoids decrease viral replication
While the ability of cannabinoids to suppress inflammation and viral replication has been reported by others and confirmed by ongoing studies in Dr. Molina's lab, the mechanisms involved are not known.
"The expected results will have a profound impact on the potential development of targeted therapeutic interventions to ameliorate HIV disease progression," notes Dr. Molina.
Source:
Leslie Capo
Louisiana State University Health Sciences Center
Protection Against Alcohol Dependence From Genetic Differences That Make You Sleepy When You Drink
Genetic differences in alcohol-metabolizing enzymes can significantly alter an individual's risk for developing alcohol dependence (AD). One variant of the alcohol dehydrogenase enzyme, ADH1B*3, is observed almost exclusively in populations with African ancestry and has also been associated with reduced rates of AD. A new study has found that greater levels of sedation in African Americans with ADH1B*3 may explain their lower rates of AD.
Results will be published in the July 2010 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.
"In one study looking at genetic samples from a number of African groups, the ADH1B*3 variant was found in almost every group," explained Denis M. McCarthy, associate professor of psychology at the University of Missouri and corresponding author for the study. "Furthermore, prior studies had shown that those with ADH1B*3 had reduced drinking and risk for AD, and this was thought to be due to the different form of ADH enzyme that people with this allele have. The goal of our study was to see if those with ADH1B*3 had different subjective and physiological response to alcohol compared to those who do not. This would be one explanation for why they drank less than others - they have a different experience from drinking."
This focus on minority populations such as African Americans is sorely needed, added Lara Ray, assistant professor in the department of psychology, and faculty member in the Brain Research Institute, at UCLA. "In the pharmacogenomics era, failure to account for genetic differences in various ethnic groups may perpetuate or even expand health disparities. In this study, the authors do a very nice job of addressing unique risk and protective genetic factors for alcoholism in African Americans.
Researchers provided a moderate alcohol dose - 0.72 g/kg for males, 0.65 g/kg for females - to 91 African American adults (52 females, 39 males) aged 21 to 26 years. All participants were genotyped for ADH1B*3 as well as additional polymorphisms that might contribute to alcohol response. Measures such as breath alcohol concentrations (BrACs), self-reports on sedation and stimulation, and pulse rates were collected both prior to alcohol consumption as well as for 2.5 hours following consumption.
Results showed that ADH1B*3 was associated with higher levels of sedation, as well as a sharper increase in pulse rate immediately following alcohol consumption.
"The unique part of this study is showing that people with this allele have a different experience when they drink - they get more sedated, particularly when their BrAC is high," said McCarthy. "This would be one explanation for their reduced drinking behavior - people are less likely to drink heavily when doing so makes them tired rather than stimulated or disinhibited. It is important for genetic research to go beyond demonstrating that a gene is related to a drinking disorder and instead demonstrating the steps by which the gene can exert its influence on that disorder."
Ray agrees. "This study provides a behavioral mechanism by which this gene may confer protection against the development of alcoholism, such that carriers of the ADH1B*3 alleles may have a more negative response to alcohol when they drink, due to differences in alcohol metabolism, which in turn protects them against heavy drinking and the subsequent development of alcohol problems," she said.
"I think the sum of research on these genes - ADH and aldehyde dehydrogenase (ALDH) variants - has important implications for understanding why people drink and how we might help people reduce problematic drinking," said McCarthy. "The treatment of AD by Antabuse™ (disulfiram) actually mimics what happens in people with ALDH2*2 variants, blocking the breakdown of acetaldehyde. It may be that eventually we can do something similar to reduce heavy alcohol use or other consequences of use by increasing the speed at which alcohol is broken down. There is also extensive research on alcohol-related birth defects and cancers, the risk for which can be affected by these genetic variants. For example, people with ADH1B*3 who still drink might be at increased risk for cancers that result from acetaldehyde."
"It is important for readers to realize that alcoholism is a disorder of complex genetics and that multiple genes and environmental factors are needed to explain this multifaceted disorder," said Ray. "This study provides evidence of genetic influences on one pathway to alcoholism; other pathways may lead to the same outcome as evidenced by the heterogeneity of alcoholism."
Source:
Denis M. McCarthy, Ph.D.
University of Missouri
Lara Ray, Ph.D.
University of California - Los Angeles
Alcoholism: Clinical & Experimental Research
Results will be published in the July 2010 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.
"In one study looking at genetic samples from a number of African groups, the ADH1B*3 variant was found in almost every group," explained Denis M. McCarthy, associate professor of psychology at the University of Missouri and corresponding author for the study. "Furthermore, prior studies had shown that those with ADH1B*3 had reduced drinking and risk for AD, and this was thought to be due to the different form of ADH enzyme that people with this allele have. The goal of our study was to see if those with ADH1B*3 had different subjective and physiological response to alcohol compared to those who do not. This would be one explanation for why they drank less than others - they have a different experience from drinking."
This focus on minority populations such as African Americans is sorely needed, added Lara Ray, assistant professor in the department of psychology, and faculty member in the Brain Research Institute, at UCLA. "In the pharmacogenomics era, failure to account for genetic differences in various ethnic groups may perpetuate or even expand health disparities. In this study, the authors do a very nice job of addressing unique risk and protective genetic factors for alcoholism in African Americans.
Researchers provided a moderate alcohol dose - 0.72 g/kg for males, 0.65 g/kg for females - to 91 African American adults (52 females, 39 males) aged 21 to 26 years. All participants were genotyped for ADH1B*3 as well as additional polymorphisms that might contribute to alcohol response. Measures such as breath alcohol concentrations (BrACs), self-reports on sedation and stimulation, and pulse rates were collected both prior to alcohol consumption as well as for 2.5 hours following consumption.
Results showed that ADH1B*3 was associated with higher levels of sedation, as well as a sharper increase in pulse rate immediately following alcohol consumption.
"The unique part of this study is showing that people with this allele have a different experience when they drink - they get more sedated, particularly when their BrAC is high," said McCarthy. "This would be one explanation for their reduced drinking behavior - people are less likely to drink heavily when doing so makes them tired rather than stimulated or disinhibited. It is important for genetic research to go beyond demonstrating that a gene is related to a drinking disorder and instead demonstrating the steps by which the gene can exert its influence on that disorder."
Ray agrees. "This study provides a behavioral mechanism by which this gene may confer protection against the development of alcoholism, such that carriers of the ADH1B*3 alleles may have a more negative response to alcohol when they drink, due to differences in alcohol metabolism, which in turn protects them against heavy drinking and the subsequent development of alcohol problems," she said.
"I think the sum of research on these genes - ADH and aldehyde dehydrogenase (ALDH) variants - has important implications for understanding why people drink and how we might help people reduce problematic drinking," said McCarthy. "The treatment of AD by Antabuse™ (disulfiram) actually mimics what happens in people with ALDH2*2 variants, blocking the breakdown of acetaldehyde. It may be that eventually we can do something similar to reduce heavy alcohol use or other consequences of use by increasing the speed at which alcohol is broken down. There is also extensive research on alcohol-related birth defects and cancers, the risk for which can be affected by these genetic variants. For example, people with ADH1B*3 who still drink might be at increased risk for cancers that result from acetaldehyde."
"It is important for readers to realize that alcoholism is a disorder of complex genetics and that multiple genes and environmental factors are needed to explain this multifaceted disorder," said Ray. "This study provides evidence of genetic influences on one pathway to alcoholism; other pathways may lead to the same outcome as evidenced by the heterogeneity of alcoholism."
Source:
Denis M. McCarthy, Ph.D.
University of Missouri
Lara Ray, Ph.D.
University of California - Los Angeles
Alcoholism: Clinical & Experimental Research
San Diego Needle Exchange Program Examined
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These are the most read articles from this news category for the last 6 months:
Kidney Transplant Recipient Infected With HIV From Live Donor - Procedure Needs Reviewing
20 Mar 2011
Despite routine screening for HIV (human immunodeficiency virus) by live donors, a kidney transplant recipient became infected, according the New York City Department of Health and Mental Hygiene...
HIV Positive Porn Actor Did Not Infect Anybody Else
06 Nov 2010
19% Of Sexually Active Gay/Bisexual Men Are HIV Positive In Parts of US Cities
25 Sep 2010
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05 Nov 2010
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01 Dec 2010
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urchinTracker();
Mental Illness By Itself Does Not Predict Future Violent Behavior
People with mental illness alone are no more likely than anyone else to commit acts of violence, a new study by UNC researchers concludes. But mental illness combined with substance abuse or dependence elevates the risk for future violence.
"Our study shows that a link between mental illness and violence does exist, but it's not as strong as most people think," said Eric B. Elbogen, Ph.D., lead author of the study and assistant professor in the forensic psychiatry program at the University of North Carolina at Chapel Hill School of Medicine.
"We found that several other factors - such as a history of past violence or substance abuse or a recent divorce or loss of one's job - are much more predictive of future violence than mental illness alone," Elbogen said. "Only when a person has both mental illness and substance abuse at the same time does that person's risk of future violence outweigh anyone else's."
UNC co-author Sally C. Johnson, M.D. added, "These findings challenge the perception some people have, and which you often see reflected in media coverage, that mental illness alone makes someone more dangerous. Our study shows that this perception is just not correct."
Elbogen and Johnson's study is published in the February 2009 issue of Archives of General Psychiatry. To arrive at their findings, they conducted statistical analyses of data collected previously as part of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) conducted by the National Institute of Alcohol Abuse and Alcoholism.
A total of 34,653 people completed interviews during the two separate waves of NESARC. Wave 1 took place from 2001-2002 while wave 2 was from 2004-2005. Wave 1 data on severe mental illness - including schizophrenia, bipolar disorder and major depression - were analyzed to predict wave 2 data on violent behavior.
The results show "that if a person has severe mental illness without substance abuse and history of violence, he or she has the same chances of being violent during the next 3 years as any other person in the general population," Elbogen and Johnson wrote.
When mental illness is combined with substance abuse, the risk for future violence reaches the level of statistical significance. However, even mental illness combined with substance abuse ranks only ninth on the study's list of the top 10 predictors of future violence. The higher ranking predictors, listed in order of their predictive value, are age (younger people are more likely to commit acts of violence), history of violence, sex (males are more prone to violence), history of juvenile detention, divorce or separation in the past year, history of physical abuse, parental criminal history and unemployment for the past year. Victimization in the past year was the tenth predictor.
"The data shows it is simplistic as well as inaccurate to say the cause of violence among mentally ill individuals is the mental illness itself ??¦ the current study finds that mental illness is clearly relevant to violence risk but that its causal roles are complex, indirect, and embedded in a web of other (and arguably more) important individual and situational cofactors to consider," the study concludes.
Source: Tom Hughes
University of North Carolina School of Medicine
"Our study shows that a link between mental illness and violence does exist, but it's not as strong as most people think," said Eric B. Elbogen, Ph.D., lead author of the study and assistant professor in the forensic psychiatry program at the University of North Carolina at Chapel Hill School of Medicine.
"We found that several other factors - such as a history of past violence or substance abuse or a recent divorce or loss of one's job - are much more predictive of future violence than mental illness alone," Elbogen said. "Only when a person has both mental illness and substance abuse at the same time does that person's risk of future violence outweigh anyone else's."
UNC co-author Sally C. Johnson, M.D. added, "These findings challenge the perception some people have, and which you often see reflected in media coverage, that mental illness alone makes someone more dangerous. Our study shows that this perception is just not correct."
Elbogen and Johnson's study is published in the February 2009 issue of Archives of General Psychiatry. To arrive at their findings, they conducted statistical analyses of data collected previously as part of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) conducted by the National Institute of Alcohol Abuse and Alcoholism.
A total of 34,653 people completed interviews during the two separate waves of NESARC. Wave 1 took place from 2001-2002 while wave 2 was from 2004-2005. Wave 1 data on severe mental illness - including schizophrenia, bipolar disorder and major depression - were analyzed to predict wave 2 data on violent behavior.
The results show "that if a person has severe mental illness without substance abuse and history of violence, he or she has the same chances of being violent during the next 3 years as any other person in the general population," Elbogen and Johnson wrote.
When mental illness is combined with substance abuse, the risk for future violence reaches the level of statistical significance. However, even mental illness combined with substance abuse ranks only ninth on the study's list of the top 10 predictors of future violence. The higher ranking predictors, listed in order of their predictive value, are age (younger people are more likely to commit acts of violence), history of violence, sex (males are more prone to violence), history of juvenile detention, divorce or separation in the past year, history of physical abuse, parental criminal history and unemployment for the past year. Victimization in the past year was the tenth predictor.
"The data shows it is simplistic as well as inaccurate to say the cause of violence among mentally ill individuals is the mental illness itself ??¦ the current study finds that mental illness is clearly relevant to violence risk but that its causal roles are complex, indirect, and embedded in a web of other (and arguably more) important individual and situational cofactors to consider," the study concludes.
Source: Tom Hughes
University of North Carolina School of Medicine
Are toddlers who cannot sleep at higher risk of becoming teens who smoke, drink or do drugs?
Long-term family study finds links between early childhood sleep problems and adolescent substance use, meaning teenagers who smoke, drink or do drugs.
ANN ARBOR, MI (USA) -- A long-term study has found a significant connection between sleep problems in children's toddler years and the chance that they'll use alcohol, cigarettes and drugs early in their teen years. Young teens whose preschool sleep habits were poor were more than twice as likely to use drugs, tobacco or alcohol.
The surprising finding, made by a University of Michigan Health System team as part of a family health study that followed 257 boys and their parents for 10 years, held true even after other issues such as depression, aggression, attention problems and parental alcoholism were taken into account. Long-term data on girls are not yet available.
Based on their result, the researchers suggest that early sleep problems may be useful as a "marker" for predicting later risk of early adolescent substance use -- and that there may be a common biological factor underlying both traits. The relationship between sleep problems and the use and abuse of alcohol in adults is well known, but this is the first study to look at the issue in children.
They also emphasize that parents should take the finding only as one more reason to focus on healthy sleep habits for their children -- not as a reason to worry.
The findings will be published in the April issue of Alcoholism: Clinical and Experimental Research by a team from the U-M Addiction Research Center (UMARC), in the Department of Psychiatry, and a colleague from Michigan State University.
The data come from an ongoing longitudinal project that uses interviews and standardized research questionnaires to look at mental and physical health issues in families over the long term. The study was recently extended for another 10 years, with further funding from the National Institutes of Health in the form of a MERIT Award.
"What's so interesting about this finding is that the effect exists regardless of a number of other factors that previously had been identified as relating to risk for substance use and abuse," says senior author and UMARC director Robert Zucker, Ph.D. "It appears to indicate some shared neurobiological dysfunction whose details we don't yet know. Further studies will be crucial to our understanding."
"Taken together with other studies in this area, our findings help make up a chain of evidence linking sleep disturbances to alcohol problems across a large segment of the life span," says lead author and research assistant professor Maria Wong, Ph.D.
The finding does not mean there's a cause-and-effect relationship, notes co-author and psychiatry professor Kirk Brower, M.D., who has studied the interplay of alcohol and sleep in adults, and is Executive Director of the Chelsea Arbor Treatment Center, which treats teen and adult substance abusers. (Chelsea Arbor is a joint program of U-M and Chelsea Community Hospital.)
"Our finding sees early childhood sleep disturbances as a marker, or predictor, for early use of drugs and alcohol in adolescence, not a predetermined trajectory," he says. "But for parents, this is one more reason to take your child's sleep problems seriously, not to dismiss them, and to talk with your child's pediatrician or family doctor."
The new study extends into early childhood the growing knowledge about how sleep and sleep disorders relate to alcohol use and alcoholism, drug use and abuse, and tobacco use.
For instance, alcoholics and non-alcoholic adults often use alcohol to try to help them sleep - even though their slumber is often disrupted when the alcohol wears off, and the amount of alcohol needed to make them sleepy grows over time as they develop a tolerance. And people with insomnia are far more likely than others to abuse alcohol, smoke and develop drug habits.
Also, several studies based on one-time interviews of teens have shown a high co-incidence of sleep problems and drug and alcohol use, although depression or aggression appeared to account for some of the effect. But the studies' designs don't allow study of causal relationships.
The new U-M study looked at data taken at three points in the boys' lives:
Ages 3-5 - The boys' mothers were asked to report whether their sons had trouble sleeping, or were overtired during the day, using the widely-used, well-validated Child Behavior Checklist (CBCL). Their answers to these two items were looked at individually, and as a combined data point labeled "sleep problems." The researchers also assessed whether either of the child's parents met the definition for alcoholism in the last three years.
Ages 9-11 - The mothers were again asked to use the CBCL to assess their sons' attention problems, level of anxiety or depression symptoms, and aggressive behavior characteristics. All three areas of behavior problems have been linked with sleep problems and/or with drug and alcohol use and abuse.
Ages 12-14 - The boys were asked to take the Drinking and other Drug Use History Questionnaire (DDHQ-Y) developed and validated by Zucker and MSU psychologist Hiram Fitzgerald, Ph.D. The anonymous questionnaire asked the young teens to report how old they had been when they first took a drink of alcohol bigger than a sip, how old they had been when they first got drunk, if they had ever smoked cigarettes and how often, and how many times they had used marijuana, inhalants, cocaine, steroids and other illicit drugs.
In all, one-third of the children were reported to have had a sleep problem in early childhood, whether trouble sleeping, overtiredness, or both. Sixty percent of the children had one parent with an alcohol problem, reflecting the larger study's weighted population. All of the children lived with both parents, and all were Caucasian. The children were from similar economic backgrounds.
By age 12 to 14, about 32 percent of the boys had started drinking alcohol, and 40 percent of that group had been drunk at least once. About one-tenth regularly smoked cigarettes, and 17 percent had used at least one kind of illicit drug.
There was no connection between parental alcoholism and children's sleep problems or behavior issues. But children of alcoholics were, as expected, more likely to have started using alcohol and drugs early in adolescence. This kind of family-associated risk is well known to exist.
The link between sleep problems and substance use was clear, even after controlling for parental alcoholism. Boys with early-childhood sleep problems were 2.3 times more likely to have started using alcohol by age 14, and 2.3 times more likely to smoke cigarettes occasionally or regularly, than boys whose mothers hadn't cited sleep problems.
They were also 2.6 times more likely to have used marijuana, and 2.2 times more likely to have used illicit drugs. The only issue to which sleep problems weren't significantly linked was the first time the boys had gotten drunk.
The researchers re-analyzed the data to examine whether the relationship between sleep problems and the early onset of substance use was in part due to the presence of attention problems, aggression and anxiety/depression. Although early childhood sleep problems predicted attention problems and anxiety/depression in late childhood, these problems did not predict the onset of substance abuse independent of sleep problems.
The researchers note that early onset of alcohol use is known to be linked to a higher risk of later alcohol abuse and dependence, as well as injuries, violence and drunk-driving. If sleep problems in early childhood might be a useful marker to signal an increased risk of early substance use, they note, sleep problem screenings could help identify children who could be at risk.
And, they say, the fact that children's sleep habits can be improved by careful attention from parents and doctors means that there's some chance the long-term risk could be addressed.
"Parents should pay attention to their children's complaints about insomnia and overtiredness," says Wong. "If necessary, they should discuss those problems with their child's health care provider. They should also set a regular sleep schedule for their child, ensure they get adequate amounts of sleep, and encourage their children to engage in relaxing, not stimulating, activities before bed."
Wong and her colleagues will continue analyzing data from the family study to look for further patterns in girls, and as the boys grow older. They also hope to use wrist-band movement monitors and brain-activity sleep tests called polysomnography to study the issue further.
Reference: Sleep problems in early childhood and early onset of alcohol and other drug use in adolescence; Alcoholism: Clinical and Experimental Research, April 2004.
Contact: Kara Gavin
kegavinumich
734-764-2220
University of Michigan Health System (USA)
ANN ARBOR, MI (USA) -- A long-term study has found a significant connection between sleep problems in children's toddler years and the chance that they'll use alcohol, cigarettes and drugs early in their teen years. Young teens whose preschool sleep habits were poor were more than twice as likely to use drugs, tobacco or alcohol.
The surprising finding, made by a University of Michigan Health System team as part of a family health study that followed 257 boys and their parents for 10 years, held true even after other issues such as depression, aggression, attention problems and parental alcoholism were taken into account. Long-term data on girls are not yet available.
Based on their result, the researchers suggest that early sleep problems may be useful as a "marker" for predicting later risk of early adolescent substance use -- and that there may be a common biological factor underlying both traits. The relationship between sleep problems and the use and abuse of alcohol in adults is well known, but this is the first study to look at the issue in children.
They also emphasize that parents should take the finding only as one more reason to focus on healthy sleep habits for their children -- not as a reason to worry.
The findings will be published in the April issue of Alcoholism: Clinical and Experimental Research by a team from the U-M Addiction Research Center (UMARC), in the Department of Psychiatry, and a colleague from Michigan State University.
The data come from an ongoing longitudinal project that uses interviews and standardized research questionnaires to look at mental and physical health issues in families over the long term. The study was recently extended for another 10 years, with further funding from the National Institutes of Health in the form of a MERIT Award.
"What's so interesting about this finding is that the effect exists regardless of a number of other factors that previously had been identified as relating to risk for substance use and abuse," says senior author and UMARC director Robert Zucker, Ph.D. "It appears to indicate some shared neurobiological dysfunction whose details we don't yet know. Further studies will be crucial to our understanding."
"Taken together with other studies in this area, our findings help make up a chain of evidence linking sleep disturbances to alcohol problems across a large segment of the life span," says lead author and research assistant professor Maria Wong, Ph.D.
The finding does not mean there's a cause-and-effect relationship, notes co-author and psychiatry professor Kirk Brower, M.D., who has studied the interplay of alcohol and sleep in adults, and is Executive Director of the Chelsea Arbor Treatment Center, which treats teen and adult substance abusers. (Chelsea Arbor is a joint program of U-M and Chelsea Community Hospital.)
"Our finding sees early childhood sleep disturbances as a marker, or predictor, for early use of drugs and alcohol in adolescence, not a predetermined trajectory," he says. "But for parents, this is one more reason to take your child's sleep problems seriously, not to dismiss them, and to talk with your child's pediatrician or family doctor."
The new study extends into early childhood the growing knowledge about how sleep and sleep disorders relate to alcohol use and alcoholism, drug use and abuse, and tobacco use.
For instance, alcoholics and non-alcoholic adults often use alcohol to try to help them sleep - even though their slumber is often disrupted when the alcohol wears off, and the amount of alcohol needed to make them sleepy grows over time as they develop a tolerance. And people with insomnia are far more likely than others to abuse alcohol, smoke and develop drug habits.
Also, several studies based on one-time interviews of teens have shown a high co-incidence of sleep problems and drug and alcohol use, although depression or aggression appeared to account for some of the effect. But the studies' designs don't allow study of causal relationships.
The new U-M study looked at data taken at three points in the boys' lives:
Ages 3-5 - The boys' mothers were asked to report whether their sons had trouble sleeping, or were overtired during the day, using the widely-used, well-validated Child Behavior Checklist (CBCL). Their answers to these two items were looked at individually, and as a combined data point labeled "sleep problems." The researchers also assessed whether either of the child's parents met the definition for alcoholism in the last three years.
Ages 9-11 - The mothers were again asked to use the CBCL to assess their sons' attention problems, level of anxiety or depression symptoms, and aggressive behavior characteristics. All three areas of behavior problems have been linked with sleep problems and/or with drug and alcohol use and abuse.
Ages 12-14 - The boys were asked to take the Drinking and other Drug Use History Questionnaire (DDHQ-Y) developed and validated by Zucker and MSU psychologist Hiram Fitzgerald, Ph.D. The anonymous questionnaire asked the young teens to report how old they had been when they first took a drink of alcohol bigger than a sip, how old they had been when they first got drunk, if they had ever smoked cigarettes and how often, and how many times they had used marijuana, inhalants, cocaine, steroids and other illicit drugs.
In all, one-third of the children were reported to have had a sleep problem in early childhood, whether trouble sleeping, overtiredness, or both. Sixty percent of the children had one parent with an alcohol problem, reflecting the larger study's weighted population. All of the children lived with both parents, and all were Caucasian. The children were from similar economic backgrounds.
By age 12 to 14, about 32 percent of the boys had started drinking alcohol, and 40 percent of that group had been drunk at least once. About one-tenth regularly smoked cigarettes, and 17 percent had used at least one kind of illicit drug.
There was no connection between parental alcoholism and children's sleep problems or behavior issues. But children of alcoholics were, as expected, more likely to have started using alcohol and drugs early in adolescence. This kind of family-associated risk is well known to exist.
The link between sleep problems and substance use was clear, even after controlling for parental alcoholism. Boys with early-childhood sleep problems were 2.3 times more likely to have started using alcohol by age 14, and 2.3 times more likely to smoke cigarettes occasionally or regularly, than boys whose mothers hadn't cited sleep problems.
They were also 2.6 times more likely to have used marijuana, and 2.2 times more likely to have used illicit drugs. The only issue to which sleep problems weren't significantly linked was the first time the boys had gotten drunk.
The researchers re-analyzed the data to examine whether the relationship between sleep problems and the early onset of substance use was in part due to the presence of attention problems, aggression and anxiety/depression. Although early childhood sleep problems predicted attention problems and anxiety/depression in late childhood, these problems did not predict the onset of substance abuse independent of sleep problems.
The researchers note that early onset of alcohol use is known to be linked to a higher risk of later alcohol abuse and dependence, as well as injuries, violence and drunk-driving. If sleep problems in early childhood might be a useful marker to signal an increased risk of early substance use, they note, sleep problem screenings could help identify children who could be at risk.
And, they say, the fact that children's sleep habits can be improved by careful attention from parents and doctors means that there's some chance the long-term risk could be addressed.
"Parents should pay attention to their children's complaints about insomnia and overtiredness," says Wong. "If necessary, they should discuss those problems with their child's health care provider. They should also set a regular sleep schedule for their child, ensure they get adequate amounts of sleep, and encourage their children to engage in relaxing, not stimulating, activities before bed."
Wong and her colleagues will continue analyzing data from the family study to look for further patterns in girls, and as the boys grow older. They also hope to use wrist-band movement monitors and brain-activity sleep tests called polysomnography to study the issue further.
Reference: Sleep problems in early childhood and early onset of alcohol and other drug use in adolescence; Alcoholism: Clinical and Experimental Research, April 2004.
Contact: Kara Gavin
kegavinumich
734-764-2220
University of Michigan Health System (USA)
Don't Smoke For One Day Drive In USA
Today is the Great American Smokeout day, when smokers are encouraged to try to refrain from smoking for one whole day. This day has existed every year for the last 30 years.
There are currently estimated to be about 46 million people in the United States who used to smoke, but don't any more. The American Cancer Society aims to see this number rise.
Over the last fifty years the percentage of adults who smoke has gradually gone down. Smoking in public places is frowned upon, and is often illegal - this was not the case many decades ago.
According to the US Centers for Disease Control and Prevention (CDC), the fall in the percentage of people who smoke in the US is flattening out. In 2004, 21% of US adults smoked, in 2005 the percentage remained the same - the first time in several years that the figure did not fall. However, it seems fewer non-smokers are breathing in second-hand smoke.
According to the American Cancer Society, public health officials aim to bring adult smoking rates down to 12% by the end of this decade. As funding for tobacco-control programs has dropped by 26% since 2002, and tobacco companies have been spending more on marketing, most experts believe the 12% target will not be met.
I became a non-smoker on May 20th this year. In a few days I celebrate 6 months as a non-smoker. I am 50 years old. One day before I quit I had a check up - my sedentary heartbeat was 78. Six weeks later my sedentary heartbeat was 57. My heart now does the same work with much less effort (compared to when I was a smoker).
Whenever I feel the urge to have a cigarette, I tell myself "Do you really want to go back up to 78?"
Two things helped me quit this time (I had tried many times in the past):
1. I tried to think of the experience as a 'liberation', rather than an abstention. I was breaking the chain of addiction, escaping from the prison that had held me for so many decades. I strongly believe the liberation approach is a more positive one - positive thinking tends to lead to better success.
2. I used nicotine replacement therapy. I spent several weeks using a nicotine inhalator. Even now I sometimes use it.
I feel much better now. I am much fitter, when I get up in the morning my throat feels clear, and I can break into a hearty laugh without coughing. Most of all, however, I am elated by the freedom I now have.
Smoking in the US: Bad News and Good News
American Cancer Society
Click here to see the article online
There are currently estimated to be about 46 million people in the United States who used to smoke, but don't any more. The American Cancer Society aims to see this number rise.
Over the last fifty years the percentage of adults who smoke has gradually gone down. Smoking in public places is frowned upon, and is often illegal - this was not the case many decades ago.
According to the US Centers for Disease Control and Prevention (CDC), the fall in the percentage of people who smoke in the US is flattening out. In 2004, 21% of US adults smoked, in 2005 the percentage remained the same - the first time in several years that the figure did not fall. However, it seems fewer non-smokers are breathing in second-hand smoke.
According to the American Cancer Society, public health officials aim to bring adult smoking rates down to 12% by the end of this decade. As funding for tobacco-control programs has dropped by 26% since 2002, and tobacco companies have been spending more on marketing, most experts believe the 12% target will not be met.
I became a non-smoker on May 20th this year. In a few days I celebrate 6 months as a non-smoker. I am 50 years old. One day before I quit I had a check up - my sedentary heartbeat was 78. Six weeks later my sedentary heartbeat was 57. My heart now does the same work with much less effort (compared to when I was a smoker).
Whenever I feel the urge to have a cigarette, I tell myself "Do you really want to go back up to 78?"
Two things helped me quit this time (I had tried many times in the past):
1. I tried to think of the experience as a 'liberation', rather than an abstention. I was breaking the chain of addiction, escaping from the prison that had held me for so many decades. I strongly believe the liberation approach is a more positive one - positive thinking tends to lead to better success.
2. I used nicotine replacement therapy. I spent several weeks using a nicotine inhalator. Even now I sometimes use it.
I feel much better now. I am much fitter, when I get up in the morning my throat feels clear, and I can break into a hearty laugh without coughing. Most of all, however, I am elated by the freedom I now have.
Smoking in the US: Bad News and Good News
American Cancer Society
Click here to see the article online
Understanding Why Methamphetamine Is So Addictive And Damaging To The Brain
Using positron emission tomography (PET) to track tracer doses of methamphetamine in humans' brains, scientists at the U.S. Department of Energy's (DOE) Brookhaven National Laboratory find that the addictive and long-lasting effects of this increasingly prevalent drug can be explained in part by its pharmacokinetics - the rate at which it enters and clears the brain, and its distribution. This study in 19 healthy, non-drug-a-busing volunteers includes a comparison with cocaine and also looked for differences by race. It will appear in the November 1, 2008, issue of Neuroimage.
"Methamphetamine is one of the most addictive and neurotoxic drugs of abuse," said Brookhaven chemist Joanna Fowler, lead author on the study. "It produces large increases in dopamine, a brain chemical associated with feelings of pleasure and reward - both by increasing dopamine's release from nerve cells and by blocking its reuptake."
Studies by Fowler and others have shown that drugs that produce greater elevations in brain dopamine tend to be more addictive. But other factors, including the speed with which a drug enters and clears the brain and its distribution within the brain, can also be important in determining its addictive and toxic potential.
In undertaking this first study of methamphetamine pharmacokinetics, the researchers also wanted to know if there were differences between Caucasians and African Americans. "Reports that the rate of methamphetamine abuse among African Americans is lower than for Caucasians led us to question whether biological or pharmacokinetic differences might explain this difference," Fowler said.
The scientists measured brain uptake, distribution, and clearance of methamphetamine by injecting 19 normal healthy men (9 Caucasian, 10 African American) with a radioactively tagged form of the drug in "trace" doses too small to have any psychoactive effects. They used PET scanning cameras to monitor the concentration and distribution of the tagged methamphetamine in the subjects' brains. On the same day, the same subjects were injected with trace doses of cocaine and scanned for comparison. The scientists also used PET to measure the number of dopamine reuptake proteins, known as dopamine transporters, available in each research subject's brain.
Like cocaine, methamphetamine entered the brain quickly, a finding consistent with both drugs' highly reinforcing effects. Methamphetamine, however, lingered in the brain significantly longer than cocaine, which cleared quickly. In fact, some brain regions, particularly white matter, still showed signs of tracer methamphetamine at the end of the 90-minute scanning session, by which time all cocaine had been cleared. The distribution of methamphetamine in the brain was remarkably different from that of cocaine. Whereas cocaine was concentrated only in the 'reward' center and cleared rapidly, methamphetamine was concentrated all over the brain, where it remained throughout the study.
"This slow clearance of methamphetamine from such widespread brain regions may help explain why the drug has such long-lasting behavioral and neurotoxic effects," Fowler said. Methamphetamine is known to produce lasting damage not only to dopamine cells but also to other brain regions, including white matter, that are not part of the dopamine network.
Surprisingly, the researchers found significant differences in cocaine pharmacokinetics between African Americans and Caucasians, with the African Americans exhibiting higher uptake of cocaine, a later rise to peak levels, and slower clearance. In contrast, the scientists found no differences in methamphetamine pharmacokinetics between these groups.
"This suggests that variables other than pharmacokinetics and bioavailability account for the lower prevalence of methamphetamine abuse in African Americans," Fowler said. "The differences observed for cocaine pharmacokinetics are surprising considering there are no differences in cocaine abuse prevalence between these two ethnic groups." These differences may merit further study, and also suggest the need to match subjects by ethnic group in future studies to avoid interference from this potentially confounding variable.
Another interesting finding was that across all research subjects, the level of dopamine transporters was directly related to the level of methamphetamine taken up by the brain. This finding suggests that transporter proteins somehow play a role in regulating the brain's uptake of this drug.
This research was funded by the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism Intramural Program, and by the Office of Biological and Environmental Research within DOE's Office of Science. Brain-imaging studies such as PET are a direct outgrowth of DOE's long-standing investment in basic research in chemistry, physics, and nuclear medicine. The ongoing neuroimaging research at Brookhaven is a prime example of how DOE's national laboratories bring together the expertise of chemists, physicists, and medical scientists to address questions of profound significance for society.
One of ten national laboratories overseen and primarily funded by the Office of Science of the U.S. Department of Energy (DOE), Brookhaven National Laboratory conducts research in the physical, biomedical, and environmental sciences, as well as in energy technologies and national security. Brookhaven Lab also builds and operates major scientific facilities available to university, industry and government researchers. Brookhaven is operated and managed for DOE's Office of Science by Brookhaven Science Associates, a limited-liability company founded by the Research Foundation of State University of New York on behalf of Stony Brook University, the largest academic user of Laboratory facilities, and Battelle, a nonprofit, applied science and technology organization.
Visit Brookhaven Lab's electronic newsroom for links, news archives, graphics, and more: bnl/newsroom
Source: Karen McNulty Walsh
DOE/Brookhaven National Laboratory
"Methamphetamine is one of the most addictive and neurotoxic drugs of abuse," said Brookhaven chemist Joanna Fowler, lead author on the study. "It produces large increases in dopamine, a brain chemical associated with feelings of pleasure and reward - both by increasing dopamine's release from nerve cells and by blocking its reuptake."
Studies by Fowler and others have shown that drugs that produce greater elevations in brain dopamine tend to be more addictive. But other factors, including the speed with which a drug enters and clears the brain and its distribution within the brain, can also be important in determining its addictive and toxic potential.
In undertaking this first study of methamphetamine pharmacokinetics, the researchers also wanted to know if there were differences between Caucasians and African Americans. "Reports that the rate of methamphetamine abuse among African Americans is lower than for Caucasians led us to question whether biological or pharmacokinetic differences might explain this difference," Fowler said.
The scientists measured brain uptake, distribution, and clearance of methamphetamine by injecting 19 normal healthy men (9 Caucasian, 10 African American) with a radioactively tagged form of the drug in "trace" doses too small to have any psychoactive effects. They used PET scanning cameras to monitor the concentration and distribution of the tagged methamphetamine in the subjects' brains. On the same day, the same subjects were injected with trace doses of cocaine and scanned for comparison. The scientists also used PET to measure the number of dopamine reuptake proteins, known as dopamine transporters, available in each research subject's brain.
Like cocaine, methamphetamine entered the brain quickly, a finding consistent with both drugs' highly reinforcing effects. Methamphetamine, however, lingered in the brain significantly longer than cocaine, which cleared quickly. In fact, some brain regions, particularly white matter, still showed signs of tracer methamphetamine at the end of the 90-minute scanning session, by which time all cocaine had been cleared. The distribution of methamphetamine in the brain was remarkably different from that of cocaine. Whereas cocaine was concentrated only in the 'reward' center and cleared rapidly, methamphetamine was concentrated all over the brain, where it remained throughout the study.
"This slow clearance of methamphetamine from such widespread brain regions may help explain why the drug has such long-lasting behavioral and neurotoxic effects," Fowler said. Methamphetamine is known to produce lasting damage not only to dopamine cells but also to other brain regions, including white matter, that are not part of the dopamine network.
Surprisingly, the researchers found significant differences in cocaine pharmacokinetics between African Americans and Caucasians, with the African Americans exhibiting higher uptake of cocaine, a later rise to peak levels, and slower clearance. In contrast, the scientists found no differences in methamphetamine pharmacokinetics between these groups.
"This suggests that variables other than pharmacokinetics and bioavailability account for the lower prevalence of methamphetamine abuse in African Americans," Fowler said. "The differences observed for cocaine pharmacokinetics are surprising considering there are no differences in cocaine abuse prevalence between these two ethnic groups." These differences may merit further study, and also suggest the need to match subjects by ethnic group in future studies to avoid interference from this potentially confounding variable.
Another interesting finding was that across all research subjects, the level of dopamine transporters was directly related to the level of methamphetamine taken up by the brain. This finding suggests that transporter proteins somehow play a role in regulating the brain's uptake of this drug.
This research was funded by the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism Intramural Program, and by the Office of Biological and Environmental Research within DOE's Office of Science. Brain-imaging studies such as PET are a direct outgrowth of DOE's long-standing investment in basic research in chemistry, physics, and nuclear medicine. The ongoing neuroimaging research at Brookhaven is a prime example of how DOE's national laboratories bring together the expertise of chemists, physicists, and medical scientists to address questions of profound significance for society.
One of ten national laboratories overseen and primarily funded by the Office of Science of the U.S. Department of Energy (DOE), Brookhaven National Laboratory conducts research in the physical, biomedical, and environmental sciences, as well as in energy technologies and national security. Brookhaven Lab also builds and operates major scientific facilities available to university, industry and government researchers. Brookhaven is operated and managed for DOE's Office of Science by Brookhaven Science Associates, a limited-liability company founded by the Research Foundation of State University of New York on behalf of Stony Brook University, the largest academic user of Laboratory facilities, and Battelle, a nonprofit, applied science and technology organization.
Visit Brookhaven Lab's electronic newsroom for links, news archives, graphics, and more: bnl/newsroom
Source: Karen McNulty Walsh
DOE/Brookhaven National Laboratory
Genetics Plays A Role In The Relapse Of Drug-seeking Behavior In Humans
Inbred strains of rats differ in how aggressively they seek cocaine after a few weeks of use, researchers say.
The finding, posted online Jan. 18 by Psychopharmacology, is another piece of evidence that genetics plays a role in the relapse of drug-seeking behavior in humans, says Dr. Paul J. Kruzich, behavioral neuroscientist at the Medical College of Georgia and lead study author.
It also fingers glutamate, a neurotransmitter involved in learning and memory, as an accomplice in stirring the cravings and uncontrollable urges that drive some drug users to use again, he says.
"Given the right environmental stimuli, all persons addicted to psychostimulants can relapse, but potentially some people are a little more susceptible than others … it's all about gene-environment interaction," says Dr. Kruzich.
He took two strains of inbred rats - Fischer 344 and Lewis - with known genetic differences, enabled each to self-adminster cocaine for 14 days, then took the drug away for a week but not the levers the animals used to access it.
During that hiatus, he adminstered a drug that stimulates glutamate receptors, possible targets for drugs of abuse.
He found that the F344 strain worked harder to get cocaine than the Lewis rats following treatment with the glutamate drug, suggesting they were more susceptible to relapse.
"Maybe 12-step programs and faith-based programs will be enough to keep some people from relapsing," says Dr. Kruzich. "For others we may have to come up with medical treatments we can use on top of those to keep them from taking drugs again."
He says there are many different versions of the hundreds of genes that may play a role in increasing the risk of relapse.
It's known that some people become addicted more quickly than others, some literally with their first use, he says. The hardest part is not getting people to stop taking drugs: that happens when they are checked in a clinic or put in jail. The real work is keeping them from relapsing when they are out of such restricted environs, he says.
"Something happens, either they see an old colleague they have used with, they go into an old environment, they have a huge stressor in life and they start to want the drug. They have drug hunger, what we call drug craving," says Dr. Kruzich. "When it gets bad enough, they engage in drug-seeking behavior."
His lab is working to identify the relapse trigger to use as a target for developing ways to curb craving and subsequent relapse.
His studies focus on an area of the brain called the nucleus accumbens core, a target for drugs of abuse long considered a pleasure center, Dr. Kruzich says. Drugs such as cocaine and methamphetamine stimulate release of dopamine in the nucleus accumbens. Dopamine is a neurotransmitter believed responsible for the euphoria that come with drug use. In fact, animals given dopamine blockers won't self-adminster drugs of abuse, and dopamine has long been a focus of drug-abuse studies.
"These drugs impinge upon the reward centers of the brain that normally food, sex, survival and adaptation impinge upon," says Dr. Kruzich. "When you are having that great piece of cheesecake and thinking, 'Oh man,' that is the kind of response these drug of abuse are evoking but much more so than that cheesecake could ever do."
Glutamate, also released in the nucleus accumbens core, may play an equally important role in drug relapse, he says. Drugs such as cocaine appear to alter glutamate neurotransmission in the core, which may contribute to the rewiring of the brain that occurs with drug use. "It's not that these drugs just damage neurons, which they can, but they rewire the circuitry of the brain so no longer is your spouse or your job or other things in your life important to you. Your brain is tricked into thinking that drugs are the most important thing for your survival," Dr. Kruzich says.
Unfortunately, drugs that restore glutamate function also produce seizures, so scientists are looking for an indirect approach to restore the misdirected rewiring.
Toni Baker
tbakermcg
Medical College of Georgia
mcg
The finding, posted online Jan. 18 by Psychopharmacology, is another piece of evidence that genetics plays a role in the relapse of drug-seeking behavior in humans, says Dr. Paul J. Kruzich, behavioral neuroscientist at the Medical College of Georgia and lead study author.
It also fingers glutamate, a neurotransmitter involved in learning and memory, as an accomplice in stirring the cravings and uncontrollable urges that drive some drug users to use again, he says.
"Given the right environmental stimuli, all persons addicted to psychostimulants can relapse, but potentially some people are a little more susceptible than others … it's all about gene-environment interaction," says Dr. Kruzich.
He took two strains of inbred rats - Fischer 344 and Lewis - with known genetic differences, enabled each to self-adminster cocaine for 14 days, then took the drug away for a week but not the levers the animals used to access it.
During that hiatus, he adminstered a drug that stimulates glutamate receptors, possible targets for drugs of abuse.
He found that the F344 strain worked harder to get cocaine than the Lewis rats following treatment with the glutamate drug, suggesting they were more susceptible to relapse.
"Maybe 12-step programs and faith-based programs will be enough to keep some people from relapsing," says Dr. Kruzich. "For others we may have to come up with medical treatments we can use on top of those to keep them from taking drugs again."
He says there are many different versions of the hundreds of genes that may play a role in increasing the risk of relapse.
It's known that some people become addicted more quickly than others, some literally with their first use, he says. The hardest part is not getting people to stop taking drugs: that happens when they are checked in a clinic or put in jail. The real work is keeping them from relapsing when they are out of such restricted environs, he says.
"Something happens, either they see an old colleague they have used with, they go into an old environment, they have a huge stressor in life and they start to want the drug. They have drug hunger, what we call drug craving," says Dr. Kruzich. "When it gets bad enough, they engage in drug-seeking behavior."
His lab is working to identify the relapse trigger to use as a target for developing ways to curb craving and subsequent relapse.
His studies focus on an area of the brain called the nucleus accumbens core, a target for drugs of abuse long considered a pleasure center, Dr. Kruzich says. Drugs such as cocaine and methamphetamine stimulate release of dopamine in the nucleus accumbens. Dopamine is a neurotransmitter believed responsible for the euphoria that come with drug use. In fact, animals given dopamine blockers won't self-adminster drugs of abuse, and dopamine has long been a focus of drug-abuse studies.
"These drugs impinge upon the reward centers of the brain that normally food, sex, survival and adaptation impinge upon," says Dr. Kruzich. "When you are having that great piece of cheesecake and thinking, 'Oh man,' that is the kind of response these drug of abuse are evoking but much more so than that cheesecake could ever do."
Glutamate, also released in the nucleus accumbens core, may play an equally important role in drug relapse, he says. Drugs such as cocaine appear to alter glutamate neurotransmission in the core, which may contribute to the rewiring of the brain that occurs with drug use. "It's not that these drugs just damage neurons, which they can, but they rewire the circuitry of the brain so no longer is your spouse or your job or other things in your life important to you. Your brain is tricked into thinking that drugs are the most important thing for your survival," Dr. Kruzich says.
Unfortunately, drugs that restore glutamate function also produce seizures, so scientists are looking for an indirect approach to restore the misdirected rewiring.
Toni Baker
tbakermcg
Medical College of Georgia
mcg
Heroin Substitute Supervision Saves Lives, UK
Researchers have identified that supervision of methadone prescribing has substantially reduced deaths among users of the heroin substitute, at a time of growing heroin addiction problems and expanded methadone prescribing.
It has long been known that treatment with methadone reduces deaths among heroin addicts but there have been historic concerns about misuse and overdoses of methadone itself.
"We've been able to identify, for the first time, dramatically reduced mortality from deaths involving methadone, despite the recognised high risk of early death in this population," says Professor John Strang of the National Addiction Centre, jointly run by SLaM and the Institute of Psychiatry, King's College London..
"We are now achieving the positive benefits from this treatment with much lower risk of the negative complications".
"And the key determinant is the introduction of supervised administration of methadone in controlled doses. That prevents stockpiling, which reduces the opportunity for overdosing or passing on methadone to others who are equally at risk."
The findings in more detail:
The research found that changes in methadone prescribing practice in the 1990s, particularly the introduction of daily supervision of doses in the early stages of treatment, have been highly effective in making methadone treatment safer - achieving a fourfold reduction in deaths involving methadone across England and Scotland. It also suggests that other changes to treatment could further reduce over-dosing from 'opioids' - heroin and synthetic substitutes. Opioids are implicated in over three-quarters of all illicit drug related deaths in the UK.
The findings are published online in the British Medical Journal on Friday 17 September. The research team developed a new measurement tool 'OD4' which measures deaths per million daily doses of methadone prescribed in a year. The study covering 1993 to 2008 looked at the effects of the introduction of supervised dosing of methadone from in Scotland (1995-2000) and England (1999-2005) and found methadone deaths per million doses declined at the same time as there was an 18-fold increase in methadone prescribing in Scotland, and a 7-fold increase in England.
The National Addiction Centre (NAC), is jointly run by the Institute of Psychiatry, King's College London and South London and Maudsley NHS Foundation Trust - both part of King's Health Partners Academic Health Sciences Centre.
To read the full article visit the British Medical Journal website.
Notes
- SLaM's Supervised Injecting Clinic provides intensive treatment for people with a severe heroin addiction, where previous orthodox drug treatment has failed. People are prescribed injectable heroin (diamorphine) or methadone, which is administered at the clinic under supervision.
- For more information on SLaM's Supervised Injecting Clinic visit here.
- Professor John Strang has been a Consultant Psychiatrist in addictions treatment for over 30 years at SLaM. He has extensive experience as a Lead Clinician in charge of a wide range of treatments in community and residential settings. His area of particular clinical expertise is heroin addiction and he is also Head of the Addictions Department at King's College London.
- For more information on Professor John Strang visit here.
- South London and Maudsley NHS Foundation Trust (SLaM) provides national services to people across the UK. It also provides mental health and substance misuse services for people living in the London Boroughs of Croydon, Lambeth, Southwark and Lewisham. In addition, the Trust provides substance misuse services for people in the London Boroughs of Bexley, Greenwich and Bromley.
Source:
South London and Maudsley NHS Foundation Trust
It has long been known that treatment with methadone reduces deaths among heroin addicts but there have been historic concerns about misuse and overdoses of methadone itself.
"We've been able to identify, for the first time, dramatically reduced mortality from deaths involving methadone, despite the recognised high risk of early death in this population," says Professor John Strang of the National Addiction Centre, jointly run by SLaM and the Institute of Psychiatry, King's College London..
"We are now achieving the positive benefits from this treatment with much lower risk of the negative complications".
"And the key determinant is the introduction of supervised administration of methadone in controlled doses. That prevents stockpiling, which reduces the opportunity for overdosing or passing on methadone to others who are equally at risk."
The findings in more detail:
The research found that changes in methadone prescribing practice in the 1990s, particularly the introduction of daily supervision of doses in the early stages of treatment, have been highly effective in making methadone treatment safer - achieving a fourfold reduction in deaths involving methadone across England and Scotland. It also suggests that other changes to treatment could further reduce over-dosing from 'opioids' - heroin and synthetic substitutes. Opioids are implicated in over three-quarters of all illicit drug related deaths in the UK.
The findings are published online in the British Medical Journal on Friday 17 September. The research team developed a new measurement tool 'OD4' which measures deaths per million daily doses of methadone prescribed in a year. The study covering 1993 to 2008 looked at the effects of the introduction of supervised dosing of methadone from in Scotland (1995-2000) and England (1999-2005) and found methadone deaths per million doses declined at the same time as there was an 18-fold increase in methadone prescribing in Scotland, and a 7-fold increase in England.
The National Addiction Centre (NAC), is jointly run by the Institute of Psychiatry, King's College London and South London and Maudsley NHS Foundation Trust - both part of King's Health Partners Academic Health Sciences Centre.
To read the full article visit the British Medical Journal website.
Notes
- SLaM's Supervised Injecting Clinic provides intensive treatment for people with a severe heroin addiction, where previous orthodox drug treatment has failed. People are prescribed injectable heroin (diamorphine) or methadone, which is administered at the clinic under supervision.
- For more information on SLaM's Supervised Injecting Clinic visit here.
- Professor John Strang has been a Consultant Psychiatrist in addictions treatment for over 30 years at SLaM. He has extensive experience as a Lead Clinician in charge of a wide range of treatments in community and residential settings. His area of particular clinical expertise is heroin addiction and he is also Head of the Addictions Department at King's College London.
- For more information on Professor John Strang visit here.
- South London and Maudsley NHS Foundation Trust (SLaM) provides national services to people across the UK. It also provides mental health and substance misuse services for people living in the London Boroughs of Croydon, Lambeth, Southwark and Lewisham. In addition, the Trust provides substance misuse services for people in the London Boroughs of Bexley, Greenwich and Bromley.
Source:
South London and Maudsley NHS Foundation Trust
China Should 'Own Up To Past Mistakes' In Dealing With HIV/AIDS, Address Discrimination, Opinion Piece Says
Although China in recent years "has made bold strides in its response to HIV/AIDS," the number of new HIV/AIDS cases will continue to increase unless the country "owns up to past mistakes, encourages and supports civil society involvement, and proactively deals with the serious challenges of stigma and misinformation," Elizabeth Williams, acting director for Asian social issue programs at the Asia Society, writes in an ABC News opinion piece. China's leadership after "years of denial" now "serves as a model for the region," Williams writes, adding that Premier Wen Jaibo, President Hu Jintao and Vice Premier Wu Yi all speak "publicly and visibly on the AIDS emergency." In addition, new "public service campaigns are attempting to increase awareness," civil society groups and the private sector are making "[i]nnovative efforts," and "new resources from public and private donors are supporting model programs for prevention, care and treatment," according to Williams. However, there are "warning signs that all is not well" and that "worse is yet to come," Williams writes, adding that the ability of nongovernmental organizations and HIV/AIDS advocates to "progress and develop has been less than successful." In addition, China's "refusal to openly discuss and address" blood collection procedures in the country's Henan province is a "building issue" because "not one official has been held accountable" for the situation, and there is "no indication that this will change," according to Williams. HIV-positive people in Henan are "under constant pressure to stay quiet," and there is a growing population of AIDS orphans in the province who "run the risk of growing up uneducated and vulnerable," Williams writes. She concludes that although China's "leaders claim to be dealing with the challenges presented in Henan," the country will "continue to sabotage its efforts to respond" to HIV/AIDS until it "owns up to its own mistakes and improves open communication about both the past and present of this epidemic" (Williams, ABC News, 1/23).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Woman Who Put Methadone In Baby's Pacifier To Stop Him Crying Jailed For Three Years
Susan Taylor, 29, from Edinburgh, Scotland has been jailed for three years for putting methadone - a heroin substitute - in a baby's pacifier (dummy) to stop him crying. Ms. Taylor admitted to a charge of culpably and recklessly causing the baby to ingest methadone, to the danger of his life in November, 2008.
Ms. Taylor said he was a "grumpy" baby. She says she rolled the pacifier in her methadone measuring cup before putting it in his mouth. He sucked on it for about five minutes and then passed out - his faced turning gray and his lips blue.
The 10-week-old child almost died, the court heard. A "huge" quantity of methadone was found in the baby's urine. Advocate depute Morag Jack, prosecuting, told the High Court in Edinburgh that it is too early to tell whether the child will suffer any lasting effects.
The case could not be reported until today because her partner was facing trial - she had admitted the charge in September, 2009.
Lynn Cowan, 28, was also jailed because Ms. Taylor had told her she had given the baby methadone - information she failed to pass on to doctors when they took him to the Royal Hospital for Sick Children.
The baby cannot be identified for legal reasons. The court was told the baby is no longer in the care of either woman.
Sequence of events:
Baby cries a lot.
Taylor gives baby methadone to stop the crying.
Baby passes out.
Cowan comes in wondering what is wrong with the baby.
Taylor tells Cowan what happened.
They take the baby to hospital, but neither of them tells the doctors about the methadone.
A urine test reveals tells doctors there is methadone in the baby's system.
What is methadone?
Methadone is a synthetic opiate, commonly used as a legal substitute for heroin in treatment programs for (heroin) drug addiction.
Ms. Taylor said he was a "grumpy" baby. She says she rolled the pacifier in her methadone measuring cup before putting it in his mouth. He sucked on it for about five minutes and then passed out - his faced turning gray and his lips blue.
The 10-week-old child almost died, the court heard. A "huge" quantity of methadone was found in the baby's urine. Advocate depute Morag Jack, prosecuting, told the High Court in Edinburgh that it is too early to tell whether the child will suffer any lasting effects.
The case could not be reported until today because her partner was facing trial - she had admitted the charge in September, 2009.
Lynn Cowan, 28, was also jailed because Ms. Taylor had told her she had given the baby methadone - information she failed to pass on to doctors when they took him to the Royal Hospital for Sick Children.
The baby cannot be identified for legal reasons. The court was told the baby is no longer in the care of either woman.
Sequence of events:
Baby cries a lot.
Taylor gives baby methadone to stop the crying.
Baby passes out.
Cowan comes in wondering what is wrong with the baby.
Taylor tells Cowan what happened.
They take the baby to hospital, but neither of them tells the doctors about the methadone.
A urine test reveals tells doctors there is methadone in the baby's system.
What is methadone?
Methadone is a synthetic opiate, commonly used as a legal substitute for heroin in treatment programs for (heroin) drug addiction.
Cause Of Smokers' Cravings Revealed By Brain Scans
Within the mind of every smoker trying to quit rages a battle between the higher-order functions of the brain wanting to break the habit and the lower-order functions screaming for another cigarette, say researchers at Duke University Medical Center. More often than not, that cigarette gets lit.
Brain scans of smokers studied by the researchers revealed three specific regions deep within the brain that appear to control dependence on nicotine and craving for cigarettes. These regions play important roles in some of the key motivations for smoking: to calm down when stressed, to achieve pleasure and to help concentration.
"If you can't calm down, can't derive pleasure and can't control yourself or concentrate, then it will be extremely difficult for you to break the habit," said lead study investigator Jed E. Rose, Ph.D., director of the Duke Center for Nicotine and Smoking Cessation Research. "These brain regions may explain why most people try to quit several times before they are successful."
Understanding how the brain responds to cigarette cravings can help doctors change nicotine cessation treatments to address all three of these components of withdrawal, Rose said. Drugs or therapies that target these regions may help smokers stave off the cravings that often spoil their attempts to quit.
The team's findings are now online in the journal Neuropsychopharmacology. The research was funded by Phillip Morris USA.
Approximately one in five Americans smokes. Even though 70 percent of smokers report that they would like to quit, only 5 percent do so successfully.
In this study, the researchers manipulated the levels of nicotine dependence and cigarette craving among 15 smokers and then scanned their brains using positron emission tomography, or PET scans, to see which areas of the brain were most active.
Three specific regions of the brain demonstrated changes in activity when the smokers craved cigarettes versus when they did not.
One region that lights up, called the thalamus, is considered to be the key relay point for sensory information flowing into the brain. Some of the symptoms of withdrawal among people trying to quit stem from the inability to focus thoughts and the feeling of being overwhelmed, and could thus be explained by changes in this region, according to the researchers. The researchers found that changes in this region were most dramatic among those who said they smoked to calm down when under stress.
Another region that lights up is a part of the pleasure system of the brain. Changes in this region, called the striatum, were most notable in people who smoked to satisfy craving and for pleasurable relaxation, the researchers said.
A third region that lights up, called the anterior cingulate cortex, is vital to cognitive functions such as conflict, self regulation, decision making and emotion. People whose brain scans showed the most differences in this region also reported that they smoked to manage their weight.
"This knowledge gives us new clues about brain mechanisms underlying addiction to cigarettes and could allow us design better methods to help smokers quit," Rose said.
Rose and his colleagues are now planning to perform brain scans on smokers undergoing nicotine replacement therapy, such as the nicotine patch, to determine how these treatments affect the same regions of the brain.
Other researchers participating in the study were Frederique M. Behm, Alfred N. Salley, James E. Bates, R. Edward Coleman, Thomas C. Hawk and Timothy G. Turkington.
Contact: Marla Vacek Broadfoot
Duke University Medical Center
Brain scans of smokers studied by the researchers revealed three specific regions deep within the brain that appear to control dependence on nicotine and craving for cigarettes. These regions play important roles in some of the key motivations for smoking: to calm down when stressed, to achieve pleasure and to help concentration.
"If you can't calm down, can't derive pleasure and can't control yourself or concentrate, then it will be extremely difficult for you to break the habit," said lead study investigator Jed E. Rose, Ph.D., director of the Duke Center for Nicotine and Smoking Cessation Research. "These brain regions may explain why most people try to quit several times before they are successful."
Understanding how the brain responds to cigarette cravings can help doctors change nicotine cessation treatments to address all three of these components of withdrawal, Rose said. Drugs or therapies that target these regions may help smokers stave off the cravings that often spoil their attempts to quit.
The team's findings are now online in the journal Neuropsychopharmacology. The research was funded by Phillip Morris USA.
Approximately one in five Americans smokes. Even though 70 percent of smokers report that they would like to quit, only 5 percent do so successfully.
In this study, the researchers manipulated the levels of nicotine dependence and cigarette craving among 15 smokers and then scanned their brains using positron emission tomography, or PET scans, to see which areas of the brain were most active.
Three specific regions of the brain demonstrated changes in activity when the smokers craved cigarettes versus when they did not.
One region that lights up, called the thalamus, is considered to be the key relay point for sensory information flowing into the brain. Some of the symptoms of withdrawal among people trying to quit stem from the inability to focus thoughts and the feeling of being overwhelmed, and could thus be explained by changes in this region, according to the researchers. The researchers found that changes in this region were most dramatic among those who said they smoked to calm down when under stress.
Another region that lights up is a part of the pleasure system of the brain. Changes in this region, called the striatum, were most notable in people who smoked to satisfy craving and for pleasurable relaxation, the researchers said.
A third region that lights up, called the anterior cingulate cortex, is vital to cognitive functions such as conflict, self regulation, decision making and emotion. People whose brain scans showed the most differences in this region also reported that they smoked to manage their weight.
"This knowledge gives us new clues about brain mechanisms underlying addiction to cigarettes and could allow us design better methods to help smokers quit," Rose said.
Rose and his colleagues are now planning to perform brain scans on smokers undergoing nicotine replacement therapy, such as the nicotine patch, to determine how these treatments affect the same regions of the brain.
Other researchers participating in the study were Frederique M. Behm, Alfred N. Salley, James E. Bates, R. Edward Coleman, Thomas C. Hawk and Timothy G. Turkington.
Contact: Marla Vacek Broadfoot
Duke University Medical Center
Drinking And Aggression Among University Students Often Depends On The Context
* Aggression and violence among university students often involve alcohol consumption.
* A new study has found that both drinking levels and drinking contexts are important.
* Aggression is more likely when students drink at a fraternity, sorority or campus residence, and when a partner is present.
* Attending parties also increases the risk of aggression, especially for women.
A significant proportion of university students experience violence, under circumstances that often involve alcohol. A new study has found that drinking at a fraternity, sorority or campus residence increases the likelihood of aggression, and that attending parties can especially increase aggression for women.
Results are published in the March issue of Alcoholism: Clinical & Experimental Research.
"A number of studies have shown that university students experience a wide range of harms related to alcohol consumption, including aggression," said Samantha Wells, a scientist at the Centre for Addiction and Mental Health and corresponding author for the study.
Aggression among university students likely reflects aggression in society, said Tim Stockwell, professor and director of the Centre for Addictions Research of B.C. at the University of Victoria. "I would not expect students to have lower or higher levels," he said. "Aggression and violence are features of group drinking situations, in general, especially where these involve groups of young men who are strangers to each other and are in competition in various ways."
To better understand what may increase risk of aggression among students, Wells and her colleagues used data collected through the 2004 Canadian Campus Survey, a national survey of 6,282 students at 40 universities. Responses from 4,387 (64.3% female, 35.7% percent male) respondents were analyzed, focusing on the students' three most recent drinking events.
"We found that that the more drinks students consumed, the greater their likelihood of experiencing aggression," said Wells. "We also found that aggression was more likely when students drank at a fraternity, sorority or residence, when their partner was present, and when they drank at three or more places on the same occasion. Drinking at a party also increased the likelihood of aggression, especially women. Conversely, aggression was less likely when students had a meal."
Given that the researchers controlled for alcohol intake as well as living arrangements, Wells said there is something about fraternities, sororities and campus residences that is particularly risky for students. "We need to understand what it is about these settings that make them particularly risky for aggression," she said. "Is it, for example, that large parties, such as keg parties, are held in these settings? Is it that drinking in these settings involves heightened concerns with masculinity?"
Wells added that the finding of greater aggression among women than men at parties was consistent with previous research showing that women tend to report aggression with people they know and at home, whereas men are more likely to report aggression with strangers in public places. "Prevention programs that focus on preparing women for the risks associated with drinking at parties might help to reduce their likelihood of experiencing aggression," she said. "However, more research ??¦ would be useful to determine, for example, who women are fighting with and whether they are victims, mutual participants, or perpetrators."
Both Wells and Stockwell suggested that findings from this study can be used for policy and prevention purposes.
"The risk of alcohol-related violence is usually associated with a combination of intoxication and certain predictable social situations," said Stockwell, "mostly involving a degree of conflict or frustration. When people are intoxicated, they are less able or inclined to resolve these situations peaceably. Measures to reduce the risk of aggression and violence need to address not only reducing conflict and stress in drinking situations but also moderating the amount people actually drink. Both the amount people drink and the drinking context - for example, the size of the drinking group, type of drinking setting, whether or not a partner is present - increased risk of alcohol-related aggression and violence."
Wells agreed. "The present research clearly identifies an important role of alcohol in aggression," she said, "therefore prevention programs need to focus on reducing excessive drinking among college students. We found that drinking with a partner actually increased the likelihood of aggression. This may reflect that aggression occurs between partners or that incidents of aggression arise due to jealousy concerns, similar to research on aggression in bars. Therefore, programs that focus on preventing partner violence and other relationship-related conflicts may be highly effective. In addition, programs that promote the consumption of food, and encourage people to stay in one place rather than going from one drinking place to another, may likewise reduce the occurrence of alcohol-related aggression."
Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "Where, with Whom, and How Much Alcohol is Consumed on Drinking Occasions Involving Aggression" Event-level Associations in a Canadian National Survey of University Students," were: Ljiljana Mihic, Paul F. Tremblay and Kathryn Graham of the Social Prevention and Health Policy Research Department at the Centre for Addiction and Mental Health; and Andr?©e Demers, of the Health and Prevention Social Research Group at the University of Montreal. The study was funded by the Canadian Institutes of Health Research.
Source:
Samantha Wells, Ph.D.
Centre for Addiction and Mental Health
Tim Stockwell, Ph.D.
University of Victoria
Alcoholism: Clinical & Experimental Research
* A new study has found that both drinking levels and drinking contexts are important.
* Aggression is more likely when students drink at a fraternity, sorority or campus residence, and when a partner is present.
* Attending parties also increases the risk of aggression, especially for women.
A significant proportion of university students experience violence, under circumstances that often involve alcohol. A new study has found that drinking at a fraternity, sorority or campus residence increases the likelihood of aggression, and that attending parties can especially increase aggression for women.
Results are published in the March issue of Alcoholism: Clinical & Experimental Research.
"A number of studies have shown that university students experience a wide range of harms related to alcohol consumption, including aggression," said Samantha Wells, a scientist at the Centre for Addiction and Mental Health and corresponding author for the study.
Aggression among university students likely reflects aggression in society, said Tim Stockwell, professor and director of the Centre for Addictions Research of B.C. at the University of Victoria. "I would not expect students to have lower or higher levels," he said. "Aggression and violence are features of group drinking situations, in general, especially where these involve groups of young men who are strangers to each other and are in competition in various ways."
To better understand what may increase risk of aggression among students, Wells and her colleagues used data collected through the 2004 Canadian Campus Survey, a national survey of 6,282 students at 40 universities. Responses from 4,387 (64.3% female, 35.7% percent male) respondents were analyzed, focusing on the students' three most recent drinking events.
"We found that that the more drinks students consumed, the greater their likelihood of experiencing aggression," said Wells. "We also found that aggression was more likely when students drank at a fraternity, sorority or residence, when their partner was present, and when they drank at three or more places on the same occasion. Drinking at a party also increased the likelihood of aggression, especially women. Conversely, aggression was less likely when students had a meal."
Given that the researchers controlled for alcohol intake as well as living arrangements, Wells said there is something about fraternities, sororities and campus residences that is particularly risky for students. "We need to understand what it is about these settings that make them particularly risky for aggression," she said. "Is it, for example, that large parties, such as keg parties, are held in these settings? Is it that drinking in these settings involves heightened concerns with masculinity?"
Wells added that the finding of greater aggression among women than men at parties was consistent with previous research showing that women tend to report aggression with people they know and at home, whereas men are more likely to report aggression with strangers in public places. "Prevention programs that focus on preparing women for the risks associated with drinking at parties might help to reduce their likelihood of experiencing aggression," she said. "However, more research ??¦ would be useful to determine, for example, who women are fighting with and whether they are victims, mutual participants, or perpetrators."
Both Wells and Stockwell suggested that findings from this study can be used for policy and prevention purposes.
"The risk of alcohol-related violence is usually associated with a combination of intoxication and certain predictable social situations," said Stockwell, "mostly involving a degree of conflict or frustration. When people are intoxicated, they are less able or inclined to resolve these situations peaceably. Measures to reduce the risk of aggression and violence need to address not only reducing conflict and stress in drinking situations but also moderating the amount people actually drink. Both the amount people drink and the drinking context - for example, the size of the drinking group, type of drinking setting, whether or not a partner is present - increased risk of alcohol-related aggression and violence."
Wells agreed. "The present research clearly identifies an important role of alcohol in aggression," she said, "therefore prevention programs need to focus on reducing excessive drinking among college students. We found that drinking with a partner actually increased the likelihood of aggression. This may reflect that aggression occurs between partners or that incidents of aggression arise due to jealousy concerns, similar to research on aggression in bars. Therefore, programs that focus on preventing partner violence and other relationship-related conflicts may be highly effective. In addition, programs that promote the consumption of food, and encourage people to stay in one place rather than going from one drinking place to another, may likewise reduce the occurrence of alcohol-related aggression."
Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "Where, with Whom, and How Much Alcohol is Consumed on Drinking Occasions Involving Aggression" Event-level Associations in a Canadian National Survey of University Students," were: Ljiljana Mihic, Paul F. Tremblay and Kathryn Graham of the Social Prevention and Health Policy Research Department at the Centre for Addiction and Mental Health; and Andr?©e Demers, of the Health and Prevention Social Research Group at the University of Montreal. The study was funded by the Canadian Institutes of Health Research.
Source:
Samantha Wells, Ph.D.
Centre for Addiction and Mental Health
Tim Stockwell, Ph.D.
University of Victoria
Alcoholism: Clinical & Experimental Research
Australian Psychological Society Supports Call For Action Following Release Of Report On Youth Alcohol Abuse
The Australian Psychological Society (APS) called attention to the release of the Australian National Council on Drugs (ANCD) report into Supporting the Families of Young People with Problematic Drug Use.
This timely report coincides with concerns raised in the past weeks by the Prime Minister, Mr. Kevin Rudd, and his Health Minister, Ms Nicola Roxon, regarding the abuse of alcohol by young people. The report is a hard-hitting reminder of the effects of alcohol on our society, and particularly of the health and social effects on young people and their families.
"The report highlights not only the issues which we are now facing in relation to teenage use of substances, and particularly of alcohol, but also emphasises the role that parents and other adults in the community play as role models and teachers. Young people are taking notice of parental models, and families need support and guidance to address this growing problem," said Ms Lynne Magor-Blatch, National Convener of the APS Interest Group "Psychology and Substance Use".
"We know that nearly all teenagers will be offered drugs, especially alcohol, but also nicotine and the full range of illegal drugs. Many will experiment with drugs, as adolescents will push the limits, and in response to peer group pressure. Also, our culture endorses drug use as a solution to bad feelings of all kinds and as a form of recreation. In this context, it is fortunate that only a minority of teenagers develop serious drug problems but for that minority, their families, and the rest of the community, the costs of this are high. This minority clearly have a vulnerability that is brought out when they are exposed to drug use, and the earlier they are given access to effective, research-based treatment, the better the chance of saving them from long-term drug use problems."
Unless there is an identifiable mental health problem, families are not yet able to access psychologists skilled to assist them in changing their own behaviour and assisting their young family members through the Medicare Benefits Scheme. This is despite the recognition by government that 50-80% of people in alcohol and other drug treatment services also have a co-occurring mental health problem.
"The Australian Government has done a great deal to increase access to psychologists for treatment of mental health problems through making items available on the Medicare Benefits Scheme, but there is an ever-increasing need for more psychologists trained in alcohol and other drug interventions, and more services in the community to assist young people and their families".
Psychologists work in the community in a variety of roles, within private practice, in general practice centres and in government and non-government agencies.
The APS is the largest professional association for psychologists in Australia, representing more than 15,700 members. The APS is committed to advancing psychology as a discipline and profession. It spreads the message that psychologists make a difference to peoples' lives, through improving psychological knowledge and community wellbeing.
Australian Psychological Society
This timely report coincides with concerns raised in the past weeks by the Prime Minister, Mr. Kevin Rudd, and his Health Minister, Ms Nicola Roxon, regarding the abuse of alcohol by young people. The report is a hard-hitting reminder of the effects of alcohol on our society, and particularly of the health and social effects on young people and their families.
"The report highlights not only the issues which we are now facing in relation to teenage use of substances, and particularly of alcohol, but also emphasises the role that parents and other adults in the community play as role models and teachers. Young people are taking notice of parental models, and families need support and guidance to address this growing problem," said Ms Lynne Magor-Blatch, National Convener of the APS Interest Group "Psychology and Substance Use".
"We know that nearly all teenagers will be offered drugs, especially alcohol, but also nicotine and the full range of illegal drugs. Many will experiment with drugs, as adolescents will push the limits, and in response to peer group pressure. Also, our culture endorses drug use as a solution to bad feelings of all kinds and as a form of recreation. In this context, it is fortunate that only a minority of teenagers develop serious drug problems but for that minority, their families, and the rest of the community, the costs of this are high. This minority clearly have a vulnerability that is brought out when they are exposed to drug use, and the earlier they are given access to effective, research-based treatment, the better the chance of saving them from long-term drug use problems."
Unless there is an identifiable mental health problem, families are not yet able to access psychologists skilled to assist them in changing their own behaviour and assisting their young family members through the Medicare Benefits Scheme. This is despite the recognition by government that 50-80% of people in alcohol and other drug treatment services also have a co-occurring mental health problem.
"The Australian Government has done a great deal to increase access to psychologists for treatment of mental health problems through making items available on the Medicare Benefits Scheme, but there is an ever-increasing need for more psychologists trained in alcohol and other drug interventions, and more services in the community to assist young people and their families".
Psychologists work in the community in a variety of roles, within private practice, in general practice centres and in government and non-government agencies.
The APS is the largest professional association for psychologists in Australia, representing more than 15,700 members. The APS is committed to advancing psychology as a discipline and profession. It spreads the message that psychologists make a difference to peoples' lives, through improving psychological knowledge and community wellbeing.
Australian Psychological Society
A New Software To Assess Driving Behaviour And Driving Risks
One of the aims imposed by the European Union in 2004 is to reduce the number of traffic accidents. However, despite the measures taken by the different administrations and the consequent decrease in the number of accidents, the results for 2010 are not close to those set by Europe. Gerardo Reveriego, a young researcher of the University of M??laga, has designed software that informs drivers of the risk situations s/he has while driving. This allows drivers to self-assess themselves and improve their driving behaviour.
'Our main idea is that the system can be used by a large number of people. That's why we have worked so that the program does not have any cost, everything is based on free software', Reveriego says. Moreover, in order to be able to use it, it is not necessary to have complex expensive accessories. 'Just with a mobile phone that has a global positioning system (GPS) and an accelerometer, users will be able to know their driving behaviour' the researcher added.
This software gathers data on the acceleration and speed of the car and after a driving route, it generates a file that is displayed on a computer. 'The route that is made can be seen on a free Google map reader, such as Google Earth. In such route, you can see a series of polygons with different colours, width and height that provide information on the levels of risk, centripetal acceleration and speed, respectively' Gerardo Reveriego explained.
For example, if we have taken a curve too fast, the program will display a series of red polygons which indicate a high risk of having an accident; certain width indicating the acceleration we had when taking the curve, and a height indicating the speed. 'The higher the acceleration, the higher the risk' , this software-designer said.
This software has several applications: 'We would like the Spanish General Traffic Directorate DGT to receive anonymous reports -provided that drivers agree with that- on the places that are a risk for drivers, as these are indicative of accident concentration spots. Therefore these spots could be corrected or signposted so as to avoid more deaths' ,Reveriego added.
This system can also be implemented in driving schools. 'Students often have difficulties to follow their instructor's commands and drive at the same time; that's why our idea is for them to have a mobile device in their cars so that they can analyse their route afterwards' this telecommunications engineer said.
Insurance companies could also be interested in using this system, as they can give a bonus or penalise depending on the driver's driving style. 'With this product, travellers transportation companies can get to know their users' level of satisfaction, as if drivers make abrupt manoeuvres this software would indicate so' Reveriego said.
In addition to the help this system supposes, this researcher is already looking for future research lines. 'One of our objectives is for cars to have this new facility from the factory. In order to do so, we would need to start collaborating with a car company interested in it. This way we would manage to implement this program in the new navigation system cars have, and then car dealers would contribute to reduce the number of accidents' he said.
Source: Andaluc?a Innova
'Our main idea is that the system can be used by a large number of people. That's why we have worked so that the program does not have any cost, everything is based on free software', Reveriego says. Moreover, in order to be able to use it, it is not necessary to have complex expensive accessories. 'Just with a mobile phone that has a global positioning system (GPS) and an accelerometer, users will be able to know their driving behaviour' the researcher added.
This software gathers data on the acceleration and speed of the car and after a driving route, it generates a file that is displayed on a computer. 'The route that is made can be seen on a free Google map reader, such as Google Earth. In such route, you can see a series of polygons with different colours, width and height that provide information on the levels of risk, centripetal acceleration and speed, respectively' Gerardo Reveriego explained.
For example, if we have taken a curve too fast, the program will display a series of red polygons which indicate a high risk of having an accident; certain width indicating the acceleration we had when taking the curve, and a height indicating the speed. 'The higher the acceleration, the higher the risk' , this software-designer said.
This software has several applications: 'We would like the Spanish General Traffic Directorate DGT to receive anonymous reports -provided that drivers agree with that- on the places that are a risk for drivers, as these are indicative of accident concentration spots. Therefore these spots could be corrected or signposted so as to avoid more deaths' ,Reveriego added.
This system can also be implemented in driving schools. 'Students often have difficulties to follow their instructor's commands and drive at the same time; that's why our idea is for them to have a mobile device in their cars so that they can analyse their route afterwards' this telecommunications engineer said.
Insurance companies could also be interested in using this system, as they can give a bonus or penalise depending on the driver's driving style. 'With this product, travellers transportation companies can get to know their users' level of satisfaction, as if drivers make abrupt manoeuvres this software would indicate so' Reveriego said.
In addition to the help this system supposes, this researcher is already looking for future research lines. 'One of our objectives is for cars to have this new facility from the factory. In order to do so, we would need to start collaborating with a car company interested in it. This way we would manage to implement this program in the new navigation system cars have, and then car dealers would contribute to reduce the number of accidents' he said.
Source: Andaluc?a Innova
One In Four Hospital Patients Is Admitted With A Mental Health Or Substance Abuse Disorder
Almost one-fourth
of all stays in U.S. community hospitals for patients age 18 and older --
7.6 million of nearly 32 million stays -- involved depressive, bipolar,
schizophrenia and other mental health disorders or substance use related
disorders in 2004, according to a new report by HHS' Agency for Healthcare
Research and Quality.
This study presents the first documentation of the full impact of
mental health and substance abuse disorders on U.S. community hospitals.
According to the report, about 1.9 million of the 7.6 million stays were
for patients who were hospitalized primarily because of a mental health or
substance abuse problem. In the other 5.7 million stays, patients were
admitted for another condition but they also were diagnosed as having a
mental health or substance abuse disorder.
Nearly two-thirds of costs were billed to the government: Medicare
covered nearly half of the stays, and 18 percent were billed to Medicaid.
Roughly 8 percent of the patients were uninsured. Private insurers were
billed for the balance. The study also found that one of every three stays
of uninsured patients was related to a mental health or substance abuse
disorder.
"Community hospitals play an important role in the treatment of people
with mental health and substance abuse disorders," said AHRQ Director
Carolyn M. Clancy, M.D. "This report gives health care policymakers an
in-depth look at the impact of mental health and substance abuse care on
the health care system."
Substance Abuse and Mental Health Services Administration Administrator
Terry Cline, Ph.D., said, "The significant number of hospital stays related
to mental health and substance use disorders signals the need for an
increased national effort to identify and intervene early before the
conditions require a hospital stay. Too often because of social stigma or
lack of understanding, individuals and health care providers don't
recognize the signs or treat mental health or substance use disorders with
the same urgency as other medical conditions."
AHRQ found that most patients with mental health and substance abuse
disorders were older. For example, although people age 80 and older
comprised only 5 percent of the U.S. population in 2004, they accounted for
nearly 21 percent of all hospital stays for these conditions -- principally
for dementia. There were also gender differences. The most frequent
admitting diagnosis for women was mood disorders, while that for men was
substance abuse.
AHRQ also found that patients who have been diagnosed with both a
mental health condition and a substance abuse disorder -- those with "dual
diagnoses" -- accounted for 1 million of the nearly 8 million stays. Nearly
half of these cases with dual diagnoses involved drug abuse, a third
involved alcohol abuse, and one in five involved both drug and alcohol
abuse.
In addition, 240,000 women hospitalized for childbirth or pregnancy
also had mental health or substance abuse problems. Four of every 10 of
these patients were between 18 and 24 years of age.
Suicide attempts accounted for nearly 179,000 hospital stays. Of these,
93 percent involved a mental health condition -- most commonly mood
disorders -- and/or substance abuse. Nearly three-quarters of these
patients were between ages 18 and 44 and more than half were women.
Poisoning, by overdosing prescription medicines or ingesting a toxic
substance was the most common way patients attempted suicide.
The report is based on 2004 data -- the latest currently available --
from AHRQ's Healthcare Cost and Utilization Project Nationwide Inpatient
Sample, a database of hospital inpatient stays that is nationally
representative of all short-term, non-federal hospitals. The data are drawn
from hospitals that comprise 90 percent of all discharges in the United
States and include all patients, regardless of insurance type, as well as
the uninsured. For details, see Care of Adults with Mental Health and
Substance Abuse Disorders in U.S. Community Hospitals, 2004 at
ahrq/data/hcup/factbk10/.
Agency for Healthcare Research and Quality
ahrq
of all stays in U.S. community hospitals for patients age 18 and older --
7.6 million of nearly 32 million stays -- involved depressive, bipolar,
schizophrenia and other mental health disorders or substance use related
disorders in 2004, according to a new report by HHS' Agency for Healthcare
Research and Quality.
This study presents the first documentation of the full impact of
mental health and substance abuse disorders on U.S. community hospitals.
According to the report, about 1.9 million of the 7.6 million stays were
for patients who were hospitalized primarily because of a mental health or
substance abuse problem. In the other 5.7 million stays, patients were
admitted for another condition but they also were diagnosed as having a
mental health or substance abuse disorder.
Nearly two-thirds of costs were billed to the government: Medicare
covered nearly half of the stays, and 18 percent were billed to Medicaid.
Roughly 8 percent of the patients were uninsured. Private insurers were
billed for the balance. The study also found that one of every three stays
of uninsured patients was related to a mental health or substance abuse
disorder.
"Community hospitals play an important role in the treatment of people
with mental health and substance abuse disorders," said AHRQ Director
Carolyn M. Clancy, M.D. "This report gives health care policymakers an
in-depth look at the impact of mental health and substance abuse care on
the health care system."
Substance Abuse and Mental Health Services Administration Administrator
Terry Cline, Ph.D., said, "The significant number of hospital stays related
to mental health and substance use disorders signals the need for an
increased national effort to identify and intervene early before the
conditions require a hospital stay. Too often because of social stigma or
lack of understanding, individuals and health care providers don't
recognize the signs or treat mental health or substance use disorders with
the same urgency as other medical conditions."
AHRQ found that most patients with mental health and substance abuse
disorders were older. For example, although people age 80 and older
comprised only 5 percent of the U.S. population in 2004, they accounted for
nearly 21 percent of all hospital stays for these conditions -- principally
for dementia. There were also gender differences. The most frequent
admitting diagnosis for women was mood disorders, while that for men was
substance abuse.
AHRQ also found that patients who have been diagnosed with both a
mental health condition and a substance abuse disorder -- those with "dual
diagnoses" -- accounted for 1 million of the nearly 8 million stays. Nearly
half of these cases with dual diagnoses involved drug abuse, a third
involved alcohol abuse, and one in five involved both drug and alcohol
abuse.
In addition, 240,000 women hospitalized for childbirth or pregnancy
also had mental health or substance abuse problems. Four of every 10 of
these patients were between 18 and 24 years of age.
Suicide attempts accounted for nearly 179,000 hospital stays. Of these,
93 percent involved a mental health condition -- most commonly mood
disorders -- and/or substance abuse. Nearly three-quarters of these
patients were between ages 18 and 44 and more than half were women.
Poisoning, by overdosing prescription medicines or ingesting a toxic
substance was the most common way patients attempted suicide.
The report is based on 2004 data -- the latest currently available --
from AHRQ's Healthcare Cost and Utilization Project Nationwide Inpatient
Sample, a database of hospital inpatient stays that is nationally
representative of all short-term, non-federal hospitals. The data are drawn
from hospitals that comprise 90 percent of all discharges in the United
States and include all patients, regardless of insurance type, as well as
the uninsured. For details, see Care of Adults with Mental Health and
Substance Abuse Disorders in U.S. Community Hospitals, 2004 at
ahrq/data/hcup/factbk10/.
Agency for Healthcare Research and Quality
ahrq
Global Survey Highlights Need For Cancer Prevention Campaigns To Correct Misbeliefs
Many people hold mistaken beliefs about what causes cancer, tending to inflate the threat from environmental factors that have relatively little impact while minimizing the hazards of behaviours well established as cancer risk factors, according to the first global survey on the topic.
The survey, conducted by Roy Morgan Research and Gallup International on behalf of the International Union of Against Cancer (UICC), identified key areas where misconceptions could be addressed and where lives could be saved.
The survey involved interviewing 29,925 people in 29 countries across the globe during the last year. It is the first study to provide internationally comparable data on perceptions about cancer risk factors. The results, which allow for comparison between high-, middle- and low-income countries, were released Wednesday at the UICC's World Cancer Congress in Geneva.
Key findings from the survey include:
- People in high-income countries were the least likely to believe that drinking alcohol increases the risk of cancer. In that group, 42% said alcohol does not increase the risk. That compares with only 26% of respondents in middle-income countries and 15% in low-income countries saying that alcohol use does not increase the risk of cancer. In fact, cancer risk rises as alcohol intake increases.
- In high-income countries, the hazards of not eating enough fruits and vegetables scored more highly as a perceived risk (59%) than alcohol intake did (51%), even though the scientific evidence for the protective effect of fruit and vegetables is weaker than the evidence that alcohol intake is harmful.
- In rich countries, stress (57%) and air pollution (78%) scored higher as perceived risk factors for cancer than did alcohol intake. However, stress is not recognized as a cause of cancer and air pollution is a minor contributor compared with alcohol consumption.
- People in low- and middle-income countries have more pessimistic beliefs about cancer treatment than those in high-income countries. One of the more important problematic beliefs in lower-income countries concerned perceptions about the curability of cancer. The survey found that in such countries 48% said that "not much can be done" to cure cancer or that they didn't know whether anything could be done. That compares with 39% in middle-income countries and 17% in high-income countries. Such a misbelief is worrying because it might deter people from participating in cancer screening programmes, which are important for saving lives.
- In general, people in all countries are more ready to accept that things outside of their control might cause cancer (such as air pollution), than things that are within their own control (such as overweight, which is a well-established cancer risk factor).
- An astonishing 75% percent of people in low-income countries said their preference was for their doctor to make all the treatment decisions. Only 8% said the doctor and patient should decide together and 9% said the patient should decide. That compares with a preference in rich countries for a more equitable decision-making style that emphasises self-determination, with 72% saying either that the decision should be made together or rest with the patient alone.
Dr David Hill, President-Elect of UICC and director of the Cancer Council Victoria in Melbourne, Australia, whose team analyzed the survey data, said governments around the world will now have solid data to use to put in place education campaigns to address these beliefs and change them to save lives.
"The survey reveals there are some big unheard messages. These kind of data help us to quantify the differences between countries and to highlight where additional efforts are needed. Some of these countries have rarely had any population survey data to help their programme planning efforts," he said.
"We know that people need to be given a reason why they should change. They need to be shown how to change; they need to be given resources or support to change; they need to remember to change and they need positive reinforcement for changing. Many of these principles can be applied in designing education programmes to encourage and support behaviour change," he said.
Dr Hill said the UICC would use the data to push a worldwide agenda to ensure people had more accurate knowledge of cancer as a basis for making cancer control programmes as effective as they can be.
High-income countries included in the survey: Australia, Austria, , Canada, Czech Republic, Greece, Israel, New Zealand, Spain, UK, USA
Middle-income countries: Bolivia, China, Dominican Republic, Georgia, Guatemala, Indonesia, Lebanon, Mexico, Panama, Peru, Philippines, Romania, Serbia, Turkey, Ukraine, Venezuela, Uruguay
Low-income countries: Kenya, Nigeria
About the International Union Against Cancer (UICC)
UICC is the only global non-governmental organization devoted exclusively to cancer prevention, treatment and care, with members in 100 countries.
International Union Against Cancer
The survey, conducted by Roy Morgan Research and Gallup International on behalf of the International Union of Against Cancer (UICC), identified key areas where misconceptions could be addressed and where lives could be saved.
The survey involved interviewing 29,925 people in 29 countries across the globe during the last year. It is the first study to provide internationally comparable data on perceptions about cancer risk factors. The results, which allow for comparison between high-, middle- and low-income countries, were released Wednesday at the UICC's World Cancer Congress in Geneva.
Key findings from the survey include:
- People in high-income countries were the least likely to believe that drinking alcohol increases the risk of cancer. In that group, 42% said alcohol does not increase the risk. That compares with only 26% of respondents in middle-income countries and 15% in low-income countries saying that alcohol use does not increase the risk of cancer. In fact, cancer risk rises as alcohol intake increases.
- In high-income countries, the hazards of not eating enough fruits and vegetables scored more highly as a perceived risk (59%) than alcohol intake did (51%), even though the scientific evidence for the protective effect of fruit and vegetables is weaker than the evidence that alcohol intake is harmful.
- In rich countries, stress (57%) and air pollution (78%) scored higher as perceived risk factors for cancer than did alcohol intake. However, stress is not recognized as a cause of cancer and air pollution is a minor contributor compared with alcohol consumption.
- People in low- and middle-income countries have more pessimistic beliefs about cancer treatment than those in high-income countries. One of the more important problematic beliefs in lower-income countries concerned perceptions about the curability of cancer. The survey found that in such countries 48% said that "not much can be done" to cure cancer or that they didn't know whether anything could be done. That compares with 39% in middle-income countries and 17% in high-income countries. Such a misbelief is worrying because it might deter people from participating in cancer screening programmes, which are important for saving lives.
- In general, people in all countries are more ready to accept that things outside of their control might cause cancer (such as air pollution), than things that are within their own control (such as overweight, which is a well-established cancer risk factor).
- An astonishing 75% percent of people in low-income countries said their preference was for their doctor to make all the treatment decisions. Only 8% said the doctor and patient should decide together and 9% said the patient should decide. That compares with a preference in rich countries for a more equitable decision-making style that emphasises self-determination, with 72% saying either that the decision should be made together or rest with the patient alone.
Dr David Hill, President-Elect of UICC and director of the Cancer Council Victoria in Melbourne, Australia, whose team analyzed the survey data, said governments around the world will now have solid data to use to put in place education campaigns to address these beliefs and change them to save lives.
"The survey reveals there are some big unheard messages. These kind of data help us to quantify the differences between countries and to highlight where additional efforts are needed. Some of these countries have rarely had any population survey data to help their programme planning efforts," he said.
"We know that people need to be given a reason why they should change. They need to be shown how to change; they need to be given resources or support to change; they need to remember to change and they need positive reinforcement for changing. Many of these principles can be applied in designing education programmes to encourage and support behaviour change," he said.
Dr Hill said the UICC would use the data to push a worldwide agenda to ensure people had more accurate knowledge of cancer as a basis for making cancer control programmes as effective as they can be.
High-income countries included in the survey: Australia, Austria, , Canada, Czech Republic, Greece, Israel, New Zealand, Spain, UK, USA
Middle-income countries: Bolivia, China, Dominican Republic, Georgia, Guatemala, Indonesia, Lebanon, Mexico, Panama, Peru, Philippines, Romania, Serbia, Turkey, Ukraine, Venezuela, Uruguay
Low-income countries: Kenya, Nigeria
About the International Union Against Cancer (UICC)
UICC is the only global non-governmental organization devoted exclusively to cancer prevention, treatment and care, with members in 100 countries.
International Union Against Cancer
Third National Survey Of Health Plans' Behavioral Health Services By Brandeis University
Brandeis University is launching two surveys of the nation's private health plans to assess how recent legislation affects quality of and consumer access to behavioral health services. Both the federal parity law and national health reform are likely to affect behavioral health care. The Brandeis 2010 and 2012 Health Plan Surveys, latest in a series begun in 1999, will track trends in how alcohol, drug abuse, and mental health services are provided for the more than 200 million privately insured individuals.
"Health plan decisions can dramatically affect the lives of people with substance abuse and mental health conditions. Now that behavioral health benefits are required to be on par with medical benefits, this survey will provide timely and important information in a field that is undergoing rapid change," said Principal Investigator Constance Horgan, director of the Institute for Behavioral Health at the Heller School. The survey will provide detailed information on how health plan changes are affecting consumers. It will examine many factors important to consumers including ease of access to behavioral health care, consumer cost sharing, and health plans' involvement in improving the health of members.
The 2010 survey will examine health plans' initial implementation of the new federal parity law and will also explore the growing role of information technology, expansion of wellness programs, use of incentives for performance and quality, and the integration of substance abuse and mental health treatment into primary care. The survey will also track changes in a broad range of domains examined in prior rounds, including screening in primary care, treatment approaches, provider payment and risk sharing, benefit design, and utilization management techniques. The 2012 survey will provide more detailed information about how health plans change services after the final parity regulations, due out shortly, go into effect.
The team of behavioral health researchers at the Heller School for Social Policy and Management at Brandeis conducted two similar surveys, in 1999 and in 2003. The new set of surveys will build on earlier efforts, to provide a current picture of the complex and changing organization of behavioral health services in private health plans in sixty markets nationwide. The information will be collected through telephone surveys of executive and medical directors of health plans and will address major products that cover most of the privately insured: health maintenance organizations (HMOs); point-of-service plans (POSs); preferred provider organizations (PPOs), and consumer-driven plans.
Survey information will be available in 2011 and will be highly useful to policy-makers tracking implementation under new rules and regulations, consumer advocacy groups, and health plan executives interested in learning how other plans are delivering services and complying with the new laws.
"The federal parity law in combination with national health care reform has the potential to transform delivery of behavioral health services. We anticipate many changes in health plan benefits and in the tools plans use to manage behavioral health benefits as a result of these federal laws," said Dr. Horgan.
The surveys are funded by the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse.
Source:
Laura Gardner
Brandeis University
"Health plan decisions can dramatically affect the lives of people with substance abuse and mental health conditions. Now that behavioral health benefits are required to be on par with medical benefits, this survey will provide timely and important information in a field that is undergoing rapid change," said Principal Investigator Constance Horgan, director of the Institute for Behavioral Health at the Heller School. The survey will provide detailed information on how health plan changes are affecting consumers. It will examine many factors important to consumers including ease of access to behavioral health care, consumer cost sharing, and health plans' involvement in improving the health of members.
The 2010 survey will examine health plans' initial implementation of the new federal parity law and will also explore the growing role of information technology, expansion of wellness programs, use of incentives for performance and quality, and the integration of substance abuse and mental health treatment into primary care. The survey will also track changes in a broad range of domains examined in prior rounds, including screening in primary care, treatment approaches, provider payment and risk sharing, benefit design, and utilization management techniques. The 2012 survey will provide more detailed information about how health plans change services after the final parity regulations, due out shortly, go into effect.
The team of behavioral health researchers at the Heller School for Social Policy and Management at Brandeis conducted two similar surveys, in 1999 and in 2003. The new set of surveys will build on earlier efforts, to provide a current picture of the complex and changing organization of behavioral health services in private health plans in sixty markets nationwide. The information will be collected through telephone surveys of executive and medical directors of health plans and will address major products that cover most of the privately insured: health maintenance organizations (HMOs); point-of-service plans (POSs); preferred provider organizations (PPOs), and consumer-driven plans.
Survey information will be available in 2011 and will be highly useful to policy-makers tracking implementation under new rules and regulations, consumer advocacy groups, and health plan executives interested in learning how other plans are delivering services and complying with the new laws.
"The federal parity law in combination with national health care reform has the potential to transform delivery of behavioral health services. We anticipate many changes in health plan benefits and in the tools plans use to manage behavioral health benefits as a result of these federal laws," said Dr. Horgan.
The surveys are funded by the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse.
Source:
Laura Gardner
Brandeis University
Local Programs Aim To Improve Culture-Based Health Services; American Indian Tribe To Participate In Federal Substance Use Effort
Cherokee Nation: The tribal group is one of five chosen to assist in a Substance Abuse and Mental Health Services Administration-sponsored project that promotes substance use prevention programs in American Indian communities, the Muskogee Phoenix reports. SAMHSA will serve as the hub for information on services and programs that aim to prevent substance abuse and related problems among American Indians (Muskogee Phoenix, 12/10).
Mental Health Association of Westchester County, N.Y.: The van Ameringen Foundation awarded the group a $50,000 grant to support expanding Nuestro Futuro, which serves Hispanics. The group will use the grant to eliminate a waiting list for bilingual and bicultural mental health services at its clinics and to expand education and outreach efforts (Westchester, 12/12).
San Joaquin County, Calif.: The county has entered a $1.1 million agreement with local not-for-profit Human Services Projects to better serve Asian, American Indian, black, Hispanic, Muslim, Middle Eastern and gay populations through its Community Behavioral Intervention Services program, the Stockton Record reports. The program, which is one of many efforts the county is planning to address minority populations, aims to help people with severe mental illnesses keep their jobs or stay in school, have stable housing and avoid hospitalization. Lynn Thomas, a county program manager, said the not-for-profit group likely will be able to help the county assess and resolve difficult situations, potentially avoiding hospitalizing patients (Johnson, Stockton Record, 12/8).
University of California-Irvine: The university has begun construction on a $40.5-million medical building that will be the home for various health programs aimed at underserved communities, including one that helps medical students prepare to work in predominately Hispanic communities, the Costa Mesa Daily Pilot reports. As part of the Program in Medical Education for the Latino Community, students will participate in a six-week cultural exchange in Mexico. The 65,000 square-foot building is expected to open in fall 2009 and will be the first UCI facility dedicated to medicine in at least two decades at the school, according to the Daily Pilot (Serna, Costa Mesa Daily Pilot, 12/7).
University of North Dakota: The school's Recruiting American Indian Nurses program this week held midyear graduation ceremonies for eight American Indian nursing students, the Grand Forks Herald reports. Before the program, few American Indians went into nursing and few people who were not American Indian wanted to work on reservations, according to the Herald. More than 90% of graduates of the program end up working on American Indian reservations in the Dakotas, Montana, Minnesota and other states (Yellow Bird, Grand Forks Herald, 12/12).
Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Mental Health Association of Westchester County, N.Y.: The van Ameringen Foundation awarded the group a $50,000 grant to support expanding Nuestro Futuro, which serves Hispanics. The group will use the grant to eliminate a waiting list for bilingual and bicultural mental health services at its clinics and to expand education and outreach efforts (Westchester, 12/12).
San Joaquin County, Calif.: The county has entered a $1.1 million agreement with local not-for-profit Human Services Projects to better serve Asian, American Indian, black, Hispanic, Muslim, Middle Eastern and gay populations through its Community Behavioral Intervention Services program, the Stockton Record reports. The program, which is one of many efforts the county is planning to address minority populations, aims to help people with severe mental illnesses keep their jobs or stay in school, have stable housing and avoid hospitalization. Lynn Thomas, a county program manager, said the not-for-profit group likely will be able to help the county assess and resolve difficult situations, potentially avoiding hospitalizing patients (Johnson, Stockton Record, 12/8).
University of California-Irvine: The university has begun construction on a $40.5-million medical building that will be the home for various health programs aimed at underserved communities, including one that helps medical students prepare to work in predominately Hispanic communities, the Costa Mesa Daily Pilot reports. As part of the Program in Medical Education for the Latino Community, students will participate in a six-week cultural exchange in Mexico. The 65,000 square-foot building is expected to open in fall 2009 and will be the first UCI facility dedicated to medicine in at least two decades at the school, according to the Daily Pilot (Serna, Costa Mesa Daily Pilot, 12/7).
University of North Dakota: The school's Recruiting American Indian Nurses program this week held midyear graduation ceremonies for eight American Indian nursing students, the Grand Forks Herald reports. Before the program, few American Indians went into nursing and few people who were not American Indian wanted to work on reservations, according to the Herald. More than 90% of graduates of the program end up working on American Indian reservations in the Dakotas, Montana, Minnesota and other states (Yellow Bird, Grand Forks Herald, 12/12).
Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Abuse Liability Study Results Of Lisdexamfetamine Dimesylate (NRP104) Presented At CPDD
Shire plc (LSE: SHP, NASDAQ: SHPGY, TSX: SHQ) announced that results of three abuse liability studies with lisdexamfetamine dimesylate (NRP104), an investigational drug for the treatment of ADHD, were presented last week at the 68th annual meeting of the College on Problems of Drug Dependence (CPDD) in Scottsdale, AZ. Principal investigator Donald Jasinski, Professor of Medicine, Chief Center for Chemical Dependence, Johns Hopkins Bayview Medical Center, presented these results.
New River Pharmaceuticals Inc. (NASDAQ: NRPH) designed lisdexamfetamine dimesylate as an inactive prodrug in which d-amphetamine is bonded to l-lysine, a naturally occurring amino acid. Lisdexamfetamine dimesylate remains inactive until converted and active d-amphetamine is gradually released. On January 31, 2005, New River signed a collaborative agreement with Shire to develop and commercialize the product and on December 6, 2005, filed a New Drug Application with the U.S. Food and Drug Administration to evaluate lisdexamfetamine dimesylate for the treatment of ADHD. This application is currently under review.
Results of "Pharmacokinetics of oral NRP104 (lisdexamfetamine dimesylate) versus d-amphetamine in healthy adults with a history of stimulant abuse"
The A01 study was designed to evaluate the safety, tolerability, and abuse liability of lisdexamfetamine dimesylate in twelve healthy adult volunteers with histories of stimulant abuse.
In this single blind, placebo- and active-controlled, single-dose escalation study, lisdexamfetamine dimesylate tended to be less euphoric than d-amphetamine sulfate 40 mg, and had a later peak effect. The systemic exposure to active d-amphetamine sulfate (AUC and Cmax) was dose proportional following a single administration of lisdexamfetamine dimesylate in doses between 30 mg and 130 mg and was attenuated between 130 mg and 150 mg. Overall, doses of lisdexamfetamine dimesylate from 30 mg to 150 mg were well tolerated in healthy adults with previous history of stimulant abuse.
Results of "Abuse liability of intravenous L-lysine-d-amphetamine (NRP104)"
The A02 study was designed to evaluate the safety, tolerability and abuse liability of intravenously administered lisdexamfetamine dimesylate in twelve healthy adult volunteers with histories of stimulant abuse. In this double-blind, three-way crossover study, 50 mg lisdexamfetamine dimesylate taken intravenously produced a lesser degree of euphoria or amphetamine-like subjective effects, when compared to a molar weight-basis equivalent amount of 20 mg d-amphetamine sulfate taken intravenously. At the end of the study, when participants in a second cohort were asked which treatment they would take again, six participants chose intravenous d-amphetamine sulfate, two chose none of the treatments, and one chose lisdexamfetamine dimesylate.
Results of "Study to Evaluate the Likeability, Safety, and Abuse Potential of NRP104 in Adults With Histories of Stimulant Abuse"
The A03 study was designed to evaluate the "likeability" of lisdexamfetamine dimesylate compared to placebo and two active controls (d-amphetamine sulfate 40 mg, a Schedule II stimulant, and diethylpropion HCl 200 mg, a Schedule IV stimulant) in thirty-six volunteers with histories of stimulant abuse. In this double-blind, randomized, placebo and active cross-over study, lisdexamfetamine dimesylate (50 mg and 100 mg) produced liking effects that were not significantly different from placebo and were less than d-amphetamine sulfate 40 mg and diethylpropion HCl 200 mg with respect to the primary end point (DRQS Liking Score). The amphetamine content in lisdexamfetamine dimesylate 100 mg is equal to that of d-amphetamine sulfate 40 mg on a molar weight basis.
In the same study, a higher dose of lisdexamfetamine dimesylate (150 mg) produced liking effects that were significantly greater than placebo. The liking effects of lisdexamfetamine dimesylate 150 mg were not statistically significantly different from either d-amphetamine sulfate 40 mg or diethylpropion HCl 200 mg, although the amphetamine content in lisdexamfetamine dimesylate 150 mg is 50 percent more than the amphetamine content of 40 mg of d-amphetamine sulfate on a molar weight basis. Also, lisdexamfetamine dimesylate 150 mg demonstrated a delay in peak liking effects by two hours when compared to both d-amphetamine sulfate 40 mg and diethylpropion HCl 200 mg.
The results of these three human abuse liability studies suggest that the abuse liability and abuse potential of lisdexamfetamine dimesylate is less than d-amphetamine sulfate.
New River Pharmaceuticals supported the trials of lisdexamfetamine dimesylate presented at CPDD.
Notes to editors
Shire plc Shire's strategic goal is to become the leading specialty pharmaceutical company that focuses on meeting the needs of the specialist physician. Shire focuses its business on central nervous system, gastrointestinal, general products and human genetic therapies. The structure is sufficiently flexible to allow Shire to target new therapeutic areas to the extent opportunities arise through acquisitions. Shire believes that a carefully selected portfolio of products with a strategically aligned and relatively small-scale sales force will deliver strong results.
Shire's focused strategy is to develop and market products for specialty physicians. Shire's in-licensing, merger and acquisition efforts are focused on products in niche markets with strong intellectual property protection either in the US or Europe.
For further information on Shire, please visit the Company's website: shire/.
"safe harbor" statement under the private securities litigation reform act of 1995
Statements included herein that are not historical facts are forward-looking statements. Such forward-looking statements involve a number of risks and uncertainties and are subject to change at any time. In the event such risks or uncertainties materialize, Shire plc's results could be materially affected. The risks and uncertainties include, but are not limited to: risks associated with the inherent uncertainty of pharmaceutical research, product development, manufacturing and commercialization; the impact of competitive products, including, but not limited to, the impact of those on Shire plc's Attention Deficit and Hyperactivity Disorder ("ADHD") franchise; patents, including but not limited to, legal challenges relating to Shire plc's ADHD franchise; government regulation and approval, including but not limited to the expected product approval dates of SPD503 (ADHD), SPD465 (ADHD), MESAVANCE TM (SPD476) (ulcerative colitis), ELAPRASE TM (I2S) (Hunter syndrome) and NRP104 (ADHD), including its scheduling classification by the Drug Enforcement Administration in the United States; Shire plc's ability to benefit from the acquisition of Transkaryotic Therapies Inc.; Shire plc's ability to secure new products for commercialization and/or development; and other risks and uncertainties detailed from time to time in Shire plc's and its predecessor registrant Shire Pharmaceuticals Group plc's filings with the US Securities and Exchange Commission, including Shire plc's Annual Report on Form 10-K for the year ended December 31, 2005.
Contact: Matt Cabrey, Shire
Porter Novelli
View drug information on Elaprase.
New River Pharmaceuticals Inc. (NASDAQ: NRPH) designed lisdexamfetamine dimesylate as an inactive prodrug in which d-amphetamine is bonded to l-lysine, a naturally occurring amino acid. Lisdexamfetamine dimesylate remains inactive until converted and active d-amphetamine is gradually released. On January 31, 2005, New River signed a collaborative agreement with Shire to develop and commercialize the product and on December 6, 2005, filed a New Drug Application with the U.S. Food and Drug Administration to evaluate lisdexamfetamine dimesylate for the treatment of ADHD. This application is currently under review.
Results of "Pharmacokinetics of oral NRP104 (lisdexamfetamine dimesylate) versus d-amphetamine in healthy adults with a history of stimulant abuse"
The A01 study was designed to evaluate the safety, tolerability, and abuse liability of lisdexamfetamine dimesylate in twelve healthy adult volunteers with histories of stimulant abuse.
In this single blind, placebo- and active-controlled, single-dose escalation study, lisdexamfetamine dimesylate tended to be less euphoric than d-amphetamine sulfate 40 mg, and had a later peak effect. The systemic exposure to active d-amphetamine sulfate (AUC and Cmax) was dose proportional following a single administration of lisdexamfetamine dimesylate in doses between 30 mg and 130 mg and was attenuated between 130 mg and 150 mg. Overall, doses of lisdexamfetamine dimesylate from 30 mg to 150 mg were well tolerated in healthy adults with previous history of stimulant abuse.
Results of "Abuse liability of intravenous L-lysine-d-amphetamine (NRP104)"
The A02 study was designed to evaluate the safety, tolerability and abuse liability of intravenously administered lisdexamfetamine dimesylate in twelve healthy adult volunteers with histories of stimulant abuse. In this double-blind, three-way crossover study, 50 mg lisdexamfetamine dimesylate taken intravenously produced a lesser degree of euphoria or amphetamine-like subjective effects, when compared to a molar weight-basis equivalent amount of 20 mg d-amphetamine sulfate taken intravenously. At the end of the study, when participants in a second cohort were asked which treatment they would take again, six participants chose intravenous d-amphetamine sulfate, two chose none of the treatments, and one chose lisdexamfetamine dimesylate.
Results of "Study to Evaluate the Likeability, Safety, and Abuse Potential of NRP104 in Adults With Histories of Stimulant Abuse"
The A03 study was designed to evaluate the "likeability" of lisdexamfetamine dimesylate compared to placebo and two active controls (d-amphetamine sulfate 40 mg, a Schedule II stimulant, and diethylpropion HCl 200 mg, a Schedule IV stimulant) in thirty-six volunteers with histories of stimulant abuse. In this double-blind, randomized, placebo and active cross-over study, lisdexamfetamine dimesylate (50 mg and 100 mg) produced liking effects that were not significantly different from placebo and were less than d-amphetamine sulfate 40 mg and diethylpropion HCl 200 mg with respect to the primary end point (DRQS Liking Score). The amphetamine content in lisdexamfetamine dimesylate 100 mg is equal to that of d-amphetamine sulfate 40 mg on a molar weight basis.
In the same study, a higher dose of lisdexamfetamine dimesylate (150 mg) produced liking effects that were significantly greater than placebo. The liking effects of lisdexamfetamine dimesylate 150 mg were not statistically significantly different from either d-amphetamine sulfate 40 mg or diethylpropion HCl 200 mg, although the amphetamine content in lisdexamfetamine dimesylate 150 mg is 50 percent more than the amphetamine content of 40 mg of d-amphetamine sulfate on a molar weight basis. Also, lisdexamfetamine dimesylate 150 mg demonstrated a delay in peak liking effects by two hours when compared to both d-amphetamine sulfate 40 mg and diethylpropion HCl 200 mg.
The results of these three human abuse liability studies suggest that the abuse liability and abuse potential of lisdexamfetamine dimesylate is less than d-amphetamine sulfate.
New River Pharmaceuticals supported the trials of lisdexamfetamine dimesylate presented at CPDD.
Notes to editors
Shire plc Shire's strategic goal is to become the leading specialty pharmaceutical company that focuses on meeting the needs of the specialist physician. Shire focuses its business on central nervous system, gastrointestinal, general products and human genetic therapies. The structure is sufficiently flexible to allow Shire to target new therapeutic areas to the extent opportunities arise through acquisitions. Shire believes that a carefully selected portfolio of products with a strategically aligned and relatively small-scale sales force will deliver strong results.
Shire's focused strategy is to develop and market products for specialty physicians. Shire's in-licensing, merger and acquisition efforts are focused on products in niche markets with strong intellectual property protection either in the US or Europe.
For further information on Shire, please visit the Company's website: shire/.
"safe harbor" statement under the private securities litigation reform act of 1995
Statements included herein that are not historical facts are forward-looking statements. Such forward-looking statements involve a number of risks and uncertainties and are subject to change at any time. In the event such risks or uncertainties materialize, Shire plc's results could be materially affected. The risks and uncertainties include, but are not limited to: risks associated with the inherent uncertainty of pharmaceutical research, product development, manufacturing and commercialization; the impact of competitive products, including, but not limited to, the impact of those on Shire plc's Attention Deficit and Hyperactivity Disorder ("ADHD") franchise; patents, including but not limited to, legal challenges relating to Shire plc's ADHD franchise; government regulation and approval, including but not limited to the expected product approval dates of SPD503 (ADHD), SPD465 (ADHD), MESAVANCE TM (SPD476) (ulcerative colitis), ELAPRASE TM (I2S) (Hunter syndrome) and NRP104 (ADHD), including its scheduling classification by the Drug Enforcement Administration in the United States; Shire plc's ability to benefit from the acquisition of Transkaryotic Therapies Inc.; Shire plc's ability to secure new products for commercialization and/or development; and other risks and uncertainties detailed from time to time in Shire plc's and its predecessor registrant Shire Pharmaceuticals Group plc's filings with the US Securities and Exchange Commission, including Shire plc's Annual Report on Form 10-K for the year ended December 31, 2005.
Contact: Matt Cabrey, Shire
Porter Novelli
View drug information on Elaprase.
Needle-Exchange Program Targets IDUs In New Mexico
New Mexico AIDS Services is targeting injection drug users in the state through needle-exchange programs in an effort to curb the spread of HIV and other bloodborne diseases, the Farmington Daily Times reports. For the past three years, the Farmington branch of NMAS has provided clean needles to IDUs, as well as information about safe injection practices to participants enrolled in the program, the Daily Times reports.
Mark Lewis, case manager with NMAS' Farmington branch, said that participants receive an I.D. card allowing them to carry clean needles from the center legally. According to the Daily Times, the strategy shifts the focus away from incarceration to harm reduction, which focuses on IDUs' health. Lewis said the program's primary goal is not to end or encourage drug use but to help IDUs use needles more safely and become healthier. The program -- which followed the state's Harm Reduction Act of 1996 -- is cost effective, according to Jimmy Schrock, the men's health project and harm reduction coordinator for NMAS. He added that treatment for HIV and hepatitis C can cost more than $10,000 and $30,000 per person annually, respectively. Clean needles cost $200 annually for the average participant in the program, according to Schrock (Giusti, Farmington Daily Times, 4/20).
Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.
© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Mark Lewis, case manager with NMAS' Farmington branch, said that participants receive an I.D. card allowing them to carry clean needles from the center legally. According to the Daily Times, the strategy shifts the focus away from incarceration to harm reduction, which focuses on IDUs' health. Lewis said the program's primary goal is not to end or encourage drug use but to help IDUs use needles more safely and become healthier. The program -- which followed the state's Harm Reduction Act of 1996 -- is cost effective, according to Jimmy Schrock, the men's health project and harm reduction coordinator for NMAS. He added that treatment for HIV and hepatitis C can cost more than $10,000 and $30,000 per person annually, respectively. Clean needles cost $200 annually for the average participant in the program, according to Schrock (Giusti, Farmington Daily Times, 4/20).
Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.
© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
College students may drink much more alcohol than they think they do
Previous research has found that college students underestimate their alcohol consumption. Recent findings confirm that
college students tend to overestimate volumes, over-pour drinks, and under-report levels of consumption. Educational
feedback appears to improve understanding of actual consumption levels.
Previous research has shown that college students tend to put too much alcohol into what is considered a "drink," likely
leading to inaccuracies in self-reported consumption, which is a mainstay of surveys on college drinking. A study in the
April issue of Alcoholism: Clinical & Experimental Research confirms that college students tend to overestimate volumes,
over-pour drinks, and under-report levels of consumption. However, educational feedback regarding definitions of standard
drinks appears to improve students' understanding of how much they actually drink.
"Just about everything we know about how much college students drink comes from survey studies," said Aaron White, assistant
professor in the department of psychiatry at Duke University Medical Center and first author of the study. "We ask them to
tell us how much they drink and we assume that their answers are totally accurate. In order for students to be accurate, they
have to know how much alcohol constitutes a single serving. It turns out that they don't. When we ask them to pour us drinks
of different types, they tend to pour too much. When we ask them to simply define how many ounces there should be in a single
drink, they tend to give us numbers that are way too big. This tells us a few things. The first is that we have totally
failed to teach students some of the most basic information about alcohol - what a single serving is. It also tells us that
students' answers on alcohol surveys are probably inaccurate. How could they be [accurate] if researchers and students have
different definitions of how big a single serving is?"
A "standard drink" is generally defined as a beverage that contains 0.6 ounces of pure alcohol. The most commonly used
standard drinks are 12 ounces of five-percent beer, five ounces of 12-percent wine, or 1.5 ounces of 40-percent (80 proof)
distilled spirits.
"The problem is that a typical drinker probably doesn't think this way," said White. "To many people, a 'drink' is one
serving regardless of how big it is. Someone who has had four gin and tonics would probably give the same answer on an
alcohol survey as someone who has had four Long Island iced teas, when in fact the latter could contain three times as much
alcohol as the former."
"A lot of health information about alcohol is conveyed in terms of 'drinks,'" added Susan Tapert, assistant professor of
psychiatry at the VA San Diego Healthcare System and the University of California at San Diego. "For example, cardiovascular
benefits have been associated with one drink per day for females and one to two drinks per day for males. It is critical for
people to understand that when these messages say 'a drink,' they do not mean a Big Gulp filled with alcohol."
For this study, researchers recruited 133 (78 males, 55 females) undergraduate students to complete an alcohol survey as well
as "free pour" a single beer, glass of wine, shot of liquor, or the amount of liquor in a mixed drink. Roughly half of the
subjects received feedback regarding their definitions of standard drinks. All participants were then resurveyed about their
recent alcohol consumption.
"We found that there is a relationship between how big someone thinks a drink should be and how much alcohol they pour when
asked to pour single drinks," said White. "The bigger the definition of a drink, the bigger the drink they pour."
"Interestingly, after receiving detailed feedback and instruction on the definition and volume of 'a drink,'" said Tapert,
"the college students became more accurate in determining drink size and consequently reported that they typically consumed a
larger number of beverages than they had previously reported. This suggests that college students, and perhaps other groups,
may underreport the amount of alcohol they consume, but that education about the definition of 'a drink' can improve the
accuracy of self-reported drinking."
"If we tell students that binge drinking - four drinks for females and five for males at a time - is dangerous and we want
them to stay under this limit, then we absolutely must do a better job of teaching them what a drink is," added White. "Not
doing so would be like telling people that it's OK to have one order of french fries per day without telling them whether we
mean small or super-sized."
White suggested that college itself would be a good place to start, either during freshman orientation or via a school-wide
e-mail. He also suggested that manufacturers of alcoholic beverages step up to the proverbial plate. "Why they are not
required to place serving-size information on their containers, or why they do not do so voluntarily, is way beyond my
understanding," he said. "If you buy grape juice in a grocery store, all you have to do is look at the label to find out how
many ounces are in a serving and how many servings are in the entire container. If that information is on grape juice, then
why isn't it on wine, which is just fermented grape juice?"
Both Tapert and White noted the implications of these findings for how alcohol researchers assess drinking behavior. "The
findings certainly do not suggest that we should stop using surveys to study college drinking," said White. "Surveys are
still one of the most powerful tools we have. The data simply suggest that we shouldn't take students' answers to questions
about how much they drink at face value until we are certain that all students are being taught how to better define standard
drinks."
"We need to improve the accuracy of self-reported drinking, so that our research can be as precise as possible," added
Tapert. "Furthermore, I would be very interested to know the extent to which older adults and adolescents make similar
estimations of their alcohol consumption."
"Teaching people what constitutes a single drink … applies to the general public, too," said White. "Most people are aware
that a drink or two per day could convey benefits for the heart. This might be true, but it's also clear that going over that
limit can increase a person's risk of a variety of diseases, particularly in women. So, it's sort of dangerous, in my
opinion, to tell people that a drink or two per day is safe without also teaching them what we mean by the term 'drink.' My
guess is that lots of people think they only have one or two drinks per day, when in fact they have much more."
Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the
International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "College Students Lack Knowledge
of Standard Drink Volumes: Implications for Definitions of Risky Drinking Based on Survey Data," were: Courtney L. Kraus,
Julie D. Flom, Lori A. Kestenbaum, Jamie R. Mitchell and Kunal Shah of the Department of Psychiatry at Duke University
Medical Center; and H. Scott Swartzwelder of the Department of Psychiatry at Duke University Medical Center and Neurology
Research Laboratories at Durham VA Medical Center. The study was funded by the Institute for Medical Research, and the
National Institute on Alcohol Abuse and Alcoholism.
Contact: Aaron M. White, Ph.D.
aaron.whiteduke
919-812-3406
Duke University Medical Center
mc.duke/index3.htm
Susan F. Tapert, Ph.D.
stapertucsd
858-552-8585 x2599
VA San Diego Healthcare System & University of California, San Diego
Alcoholism: Clinical & Experimental Research
alcoholism-cer
college students tend to overestimate volumes, over-pour drinks, and under-report levels of consumption. Educational
feedback appears to improve understanding of actual consumption levels.
Previous research has shown that college students tend to put too much alcohol into what is considered a "drink," likely
leading to inaccuracies in self-reported consumption, which is a mainstay of surveys on college drinking. A study in the
April issue of Alcoholism: Clinical & Experimental Research confirms that college students tend to overestimate volumes,
over-pour drinks, and under-report levels of consumption. However, educational feedback regarding definitions of standard
drinks appears to improve students' understanding of how much they actually drink.
"Just about everything we know about how much college students drink comes from survey studies," said Aaron White, assistant
professor in the department of psychiatry at Duke University Medical Center and first author of the study. "We ask them to
tell us how much they drink and we assume that their answers are totally accurate. In order for students to be accurate, they
have to know how much alcohol constitutes a single serving. It turns out that they don't. When we ask them to pour us drinks
of different types, they tend to pour too much. When we ask them to simply define how many ounces there should be in a single
drink, they tend to give us numbers that are way too big. This tells us a few things. The first is that we have totally
failed to teach students some of the most basic information about alcohol - what a single serving is. It also tells us that
students' answers on alcohol surveys are probably inaccurate. How could they be [accurate] if researchers and students have
different definitions of how big a single serving is?"
A "standard drink" is generally defined as a beverage that contains 0.6 ounces of pure alcohol. The most commonly used
standard drinks are 12 ounces of five-percent beer, five ounces of 12-percent wine, or 1.5 ounces of 40-percent (80 proof)
distilled spirits.
"The problem is that a typical drinker probably doesn't think this way," said White. "To many people, a 'drink' is one
serving regardless of how big it is. Someone who has had four gin and tonics would probably give the same answer on an
alcohol survey as someone who has had four Long Island iced teas, when in fact the latter could contain three times as much
alcohol as the former."
"A lot of health information about alcohol is conveyed in terms of 'drinks,'" added Susan Tapert, assistant professor of
psychiatry at the VA San Diego Healthcare System and the University of California at San Diego. "For example, cardiovascular
benefits have been associated with one drink per day for females and one to two drinks per day for males. It is critical for
people to understand that when these messages say 'a drink,' they do not mean a Big Gulp filled with alcohol."
For this study, researchers recruited 133 (78 males, 55 females) undergraduate students to complete an alcohol survey as well
as "free pour" a single beer, glass of wine, shot of liquor, or the amount of liquor in a mixed drink. Roughly half of the
subjects received feedback regarding their definitions of standard drinks. All participants were then resurveyed about their
recent alcohol consumption.
"We found that there is a relationship between how big someone thinks a drink should be and how much alcohol they pour when
asked to pour single drinks," said White. "The bigger the definition of a drink, the bigger the drink they pour."
"Interestingly, after receiving detailed feedback and instruction on the definition and volume of 'a drink,'" said Tapert,
"the college students became more accurate in determining drink size and consequently reported that they typically consumed a
larger number of beverages than they had previously reported. This suggests that college students, and perhaps other groups,
may underreport the amount of alcohol they consume, but that education about the definition of 'a drink' can improve the
accuracy of self-reported drinking."
"If we tell students that binge drinking - four drinks for females and five for males at a time - is dangerous and we want
them to stay under this limit, then we absolutely must do a better job of teaching them what a drink is," added White. "Not
doing so would be like telling people that it's OK to have one order of french fries per day without telling them whether we
mean small or super-sized."
White suggested that college itself would be a good place to start, either during freshman orientation or via a school-wide
e-mail. He also suggested that manufacturers of alcoholic beverages step up to the proverbial plate. "Why they are not
required to place serving-size information on their containers, or why they do not do so voluntarily, is way beyond my
understanding," he said. "If you buy grape juice in a grocery store, all you have to do is look at the label to find out how
many ounces are in a serving and how many servings are in the entire container. If that information is on grape juice, then
why isn't it on wine, which is just fermented grape juice?"
Both Tapert and White noted the implications of these findings for how alcohol researchers assess drinking behavior. "The
findings certainly do not suggest that we should stop using surveys to study college drinking," said White. "Surveys are
still one of the most powerful tools we have. The data simply suggest that we shouldn't take students' answers to questions
about how much they drink at face value until we are certain that all students are being taught how to better define standard
drinks."
"We need to improve the accuracy of self-reported drinking, so that our research can be as precise as possible," added
Tapert. "Furthermore, I would be very interested to know the extent to which older adults and adolescents make similar
estimations of their alcohol consumption."
"Teaching people what constitutes a single drink … applies to the general public, too," said White. "Most people are aware
that a drink or two per day could convey benefits for the heart. This might be true, but it's also clear that going over that
limit can increase a person's risk of a variety of diseases, particularly in women. So, it's sort of dangerous, in my
opinion, to tell people that a drink or two per day is safe without also teaching them what we mean by the term 'drink.' My
guess is that lots of people think they only have one or two drinks per day, when in fact they have much more."
Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the
International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "College Students Lack Knowledge
of Standard Drink Volumes: Implications for Definitions of Risky Drinking Based on Survey Data," were: Courtney L. Kraus,
Julie D. Flom, Lori A. Kestenbaum, Jamie R. Mitchell and Kunal Shah of the Department of Psychiatry at Duke University
Medical Center; and H. Scott Swartzwelder of the Department of Psychiatry at Duke University Medical Center and Neurology
Research Laboratories at Durham VA Medical Center. The study was funded by the Institute for Medical Research, and the
National Institute on Alcohol Abuse and Alcoholism.
Contact: Aaron M. White, Ph.D.
aaron.whiteduke
919-812-3406
Duke University Medical Center
mc.duke/index3.htm
Susan F. Tapert, Ph.D.
stapertucsd
858-552-8585 x2599
VA San Diego Healthcare System & University of California, San Diego
Alcoholism: Clinical & Experimental Research
alcoholism-cer
Better Service Integration Needed For Co-Occurring Substance Use And Mental Disorders
Canadians are becoming aware of the prevalence of mental health issues and of substance use problems, but how well equipped are we to help the many people who contend with both?
Two studies published in the December issue of the Canadian Journal of Psychiatry have found that multilevel integration is needed for mental health and substance use services to adequately address the needs of people diagnosed with co-occurring disorders. Both studies explored the prevalence of concurrent disorders, first at the provincial level among people served by the community mental health system, and then at the national level among the general population. This new research highlights the need for system-wide planning and improved integration of the mental health and addictions systems.
In the study titled, Prevalence and Profile of People with Co-occurring Mental and Substance Use Disorders Within a Comprehensive Mental Health System, Dr. Brian Rush, Senior Scientist at the Centre for Addiction and Mental Health (CAMH) and Principal Investigator on both studies found that mental health and substance use disorders co-occur in approximately 20 percent - or one in five - of people treated for mental disorders in Ontario's hospitals and mental health clinics.
"We found that co-occurring disorders were highest in selected sub-groups, for example, among younger adults (55%), people receiving specialty inpatient care (28%), and those with personality disorders (34%). It is important that risk management strategies be included in treatment and support models for clients," says Dr. Rush. "We also found that across all levels of care, having a co-occurring disorder was strongly associated with antisocial and challenging behaviour, legal involvement, and risk of suicide or self-harm."
In the second study, Prevalence of Co-occurring Substance Use and Other Mental Disorders in the Canadian Population, which looked at concurrent disorders at the national level, Dr. Rush found that almost two per cent of Canadians - or 435,000 adults - have both a mental and a substance use disorder. About 20% of people with a mental disorder had a co-occurring substance use problem. The findings underscore the need for cooperation between mental health and substance use services at the provincial, territorial, and national levels.
The first to measure the national prevalence of the co-occurrence of certain psychiatric disorders and substance use problems in Canada, the study found that, relative to national estimates, the rate of co-occurring disorders was found to be highest in British Columbia and lowest in Quebec.
The data places Canadian rates at the lower end of the international range. However, Dr. Rush notes that the problem may be much larger than the numbers indicate as several types of mental disorders and certain populations known to be at high risk for co-occurring disorders - homeless, institutionalized, and Aboriginal people, for example - were not included in Statistics Canada's 2002 Canadian Community Health Survey: Mental Health and Well-Being, on which the authors based their analysis.
The populations affected by co-occurring disorders are diverse, and each person has a unique diagnostic profile and unique strengths and needs, speaking to the importance of different models of integrated services and support. The research concludes that a targeted response to more integrated services is needed, including working with hospital and community-based services, and with a focus on integrated training.
"Identifying individuals who need help with both problems is the first step in providing tailored mental health treatment and support programs," says Dr. Rush. "One of the issues is that clinicians specialized in either addiction or mental health may not be able to recognize the co-occurring disorder(s) and the client will not get a proper diagnosis and treatment and support plan."
The Centre for Addiction and Mental Health (CAMH) is Canada's largest mental health and addiction teaching hospital, as well as one of the world's leading research centres in the area of addiction and mental health. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental health and addiction issues.
CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre.
Source: Michael Torres
Centre for Addiction and Mental Health
Two studies published in the December issue of the Canadian Journal of Psychiatry have found that multilevel integration is needed for mental health and substance use services to adequately address the needs of people diagnosed with co-occurring disorders. Both studies explored the prevalence of concurrent disorders, first at the provincial level among people served by the community mental health system, and then at the national level among the general population. This new research highlights the need for system-wide planning and improved integration of the mental health and addictions systems.
In the study titled, Prevalence and Profile of People with Co-occurring Mental and Substance Use Disorders Within a Comprehensive Mental Health System, Dr. Brian Rush, Senior Scientist at the Centre for Addiction and Mental Health (CAMH) and Principal Investigator on both studies found that mental health and substance use disorders co-occur in approximately 20 percent - or one in five - of people treated for mental disorders in Ontario's hospitals and mental health clinics.
"We found that co-occurring disorders were highest in selected sub-groups, for example, among younger adults (55%), people receiving specialty inpatient care (28%), and those with personality disorders (34%). It is important that risk management strategies be included in treatment and support models for clients," says Dr. Rush. "We also found that across all levels of care, having a co-occurring disorder was strongly associated with antisocial and challenging behaviour, legal involvement, and risk of suicide or self-harm."
In the second study, Prevalence of Co-occurring Substance Use and Other Mental Disorders in the Canadian Population, which looked at concurrent disorders at the national level, Dr. Rush found that almost two per cent of Canadians - or 435,000 adults - have both a mental and a substance use disorder. About 20% of people with a mental disorder had a co-occurring substance use problem. The findings underscore the need for cooperation between mental health and substance use services at the provincial, territorial, and national levels.
The first to measure the national prevalence of the co-occurrence of certain psychiatric disorders and substance use problems in Canada, the study found that, relative to national estimates, the rate of co-occurring disorders was found to be highest in British Columbia and lowest in Quebec.
The data places Canadian rates at the lower end of the international range. However, Dr. Rush notes that the problem may be much larger than the numbers indicate as several types of mental disorders and certain populations known to be at high risk for co-occurring disorders - homeless, institutionalized, and Aboriginal people, for example - were not included in Statistics Canada's 2002 Canadian Community Health Survey: Mental Health and Well-Being, on which the authors based their analysis.
The populations affected by co-occurring disorders are diverse, and each person has a unique diagnostic profile and unique strengths and needs, speaking to the importance of different models of integrated services and support. The research concludes that a targeted response to more integrated services is needed, including working with hospital and community-based services, and with a focus on integrated training.
"Identifying individuals who need help with both problems is the first step in providing tailored mental health treatment and support programs," says Dr. Rush. "One of the issues is that clinicians specialized in either addiction or mental health may not be able to recognize the co-occurring disorder(s) and the client will not get a proper diagnosis and treatment and support plan."
The Centre for Addiction and Mental Health (CAMH) is Canada's largest mental health and addiction teaching hospital, as well as one of the world's leading research centres in the area of addiction and mental health. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental health and addiction issues.
CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre.
Source: Michael Torres
Centre for Addiction and Mental Health
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