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Friday, April 20, 2012

Weekly ATOD News Recap - Week-ending April 20, 2012

A Drug Policy for the 21st Century

By: Kathleen Sebelius, Secretary of Health and Human Services, Eric Holder, U.S. Attorney General and Gil Kerlikowske, Director of the White House Office of National Drug Control Policy

Illegal drugs not only harm a user’s mind and body, they devastate families, communities, and neighborhoods. They jeopardize public safety, prevent too many Americans from reaching their full potential, and place obstacles in the way of raising a healthy generation of young people.

To address these challenges, today we are releasing the 2012 National Drug Control Strategy – the Obama Administration’s primary policy blueprint for reducing drug use and its consequences in America. The President’s inaugural National Drug Control Strategy, published in 2010, charted a new direction in our approach to drug policy. Today’s Strategy builds upon that approach, which is based on science, evidence, and research. Most important, it is based on the premise that drug addiction is a chronic disease of the brain that can be prevented and treated. Simply put, we are not powerless against the challenge of substance abuse – people can recover, and millions are in recovery. These individuals are our neighbors, friends and family members. They contribute to our communities, our workforce, our economy, and help make America stronger.

Our emphasis on addressing the drug problem through a public health approach is grounded in decades of research and scientific study. There is overwhelming evidence that drug prevention and treatment programs achieve meaningful results with significant long-term cost savings. In fact, recent research has shown that each dollar invested in an evidence-based prevention program can reduce costs related to substance use disorders by an average of $18.

But reducing the burden of our Nation’s drug problem stretches beyond prevention and treatment. We need an all of the above approach. To address this problem in a comprehensive way, the President’s new Strategy also applies the principles of public health to reforming the criminal justice system, which continues to play a vital role in drug policy. It outlines ways to break the cycle of drug use, crime, incarceration, and arrest by diverting non-violent drug offenders into treatment, bolstering support for reentry programs that help offenders rejoin their communities, and advancing support for innovative enforcement programs proven to improve public health while protecting public safety.

Together, we have achieved significant reform in the way we address substance abuse. And the Affordable Care Act will – for the first time - require insurers to cover treatment for drug addiction the same way they would other chronic diseases. This is a revolutionary shift in how we address drug policy in America.

Over the past three decades, we have reduced illegal drug use in America. Over the long term, rates of drug use among young people today are far lower than they were 30 years ago. More recently cocaine use has dropped nearly 40 percent and meth use has dropped by half. And we can do more. As President Obama has noted, we have successfully changed attitudes regarding rates of smoking and drunk driving, and with your help we can do the same with our illegal drug problem.
Substance Abusers, Even Recovering Ones, May Face Stigma

Scenarios of obese people, smokers drew less negative reaction in study

People are more likely to disapprove of and avoid substance abusers than those who smoke or are obese, according to a new study. Participants were presented with six fictitious scenarios about a person who either abused substances such as alcohol or drugs, smoked, or was obese. "Specifically, participants rated their willingness for the individual in the fictitious scenario to marry into their family, be friends, socialize, work on a job, be a neighbor, and have one's child date," study author Lindsay Phillips, an assistant professor of psychology at Albright College in Reading, Pa., said in a college news release.

As expected, "people who were actively using substances were the most highly stigmatized group, receiving a high level of reported intention to be socially distant from the individual," Phillips said.

The results support previous research that found substance abusers were more stigmatized than people with depression or schizophrenia. However, this new study also found that even former substance abusers still face high levels of social scorn. "Although being in remission results in substantially less stigma for smoking and obesity, stigma is only slightly decreased for individuals in remission from substance use," Phillips said. The findings are troubling because past studies have suggested that stigma can discourage substance abusers from seeking help and make them believe that they can't change their ways, Phillips said.

The study is published online in the Journal of Substance Use.
Teens Say Drinking and Driving Riskier Than Texting and Driving, Survey Finds

A new survey finds U.S. teens think drinking and driving is riskier than texting and driving, despite research that indicates they can be equally dangerous. The State Farm survey included 652 teens ages 14 to 17. Of the teens who intend to have or already have a driver’s license, 57 percent strongly agree that regularly drinking while driving eventually would be deadly, while 35 percent strongly agreed that if they regularly text and drive they will be killed someday. Among teens with a driver’s license, 57 percent admitted to texting while driving, UPI reports. The adolescents who said they did not text while driving were much more likely to report having frequent conversations with their parents about safe driving, the article notes.
Chris Mullen, Director of Technology Research at State Farm, said research indicates the consequences of texting while driving can be as dangerous as drunk driving.
Teens who refrained from texting while driving were much more likely to report having frequent talks with their parents about safe driving. Once teenagers receive their license, there is a sharp dropoff in conversations between parents and teens about driving, the survey shows. “The conversation should not end when teens get their license,” Mullen said in a news release. “Through this survey and other teen driver research, we know that ongoing parental involvement in the learning process is key to keeping teen drivers safe behind the wheel.” The results of the survey are virtually unchanged from a similar survey conducted in 2010.
Substance Use More Highly Stigmatized Than Smoking or Obesity, Study Suggests

People who abuse substances are more likely to be stigmatized than those who smoke or are obese, a new study suggests. The study of 161 adults presented participants with six fictitious scenarios about people who either abused substances, smoked or were obese, according to HealthDay. “Specifically, participants rated their willingness for the individual in the fictitious scenario to marry into their family, be friends, socialize, work on a job, be a neighbor, and have one’s child date,” study author Lindsay Phillips of Albright College in Reading, Pennsylvania, said in a college news release. She found people who were actively using substances were the most highly stigmatized group. The study found even people who formerly abused substances still face high levels of stigma. Phillips said this was troubling, because previous research has suggested stigma can discourage people from seeking help for substance abuse, and make them believe they cannot change their ways. The findings are published in the Journal of Substance Use.
Sharp Increase in Prescription Drug Poisonings Among Teens Reported

Poisoning deaths among teenagers rose 91 percent between 2000 and 2009, primarily due to prescription drug abuse, according to a new report by the Centers for Disease Control and Prevention (CDC). Prescription drug abuse appears to be replacing marijuana as a “gateway drug” that leads to the abuse of harder drugs, said Dr. Julie Gilchrist of the CDC’s Division of Unintentional Injury Prevention. Overall, death rates from unintentional injuries of children and teenagers decreased by almost 30 percent between 2000 and 2009, in large part because of a 41 percent drop in motor vehicle deaths, according to the Los Angeles Times. Drug poisoning deaths among teens could be reduced by appropriate prescribing, proper storage and disposal, discouraging sharing of medication, and state-based prescription drug monitoring programs, the CDC stated in a press release. According to the agency, the percentage of poisoning deaths among teens ages 15 to 19 with prescription drugs as a contributing cause rose from 30 percent in 2000, to 57 percent in 2009.
Depression, Anxiety Top Reasons Older Adults Abuse Drugs or Alcohol, Survey Finds

Depression and anxiety are the top reasons older adults abuse drugs or alcohol, according to a study by a Florida drug and alcohol treatment and recovery center. The study, conducted by the Hanley Center, found 63 percent of older adults blamed depression and anxiety for their substance use. Thirty percent said economic and financial stress was to blame, while 20 percent cited retirement as contributing factors to dependency. Almost half of survey respondents named both prescription drugs and alcohol as their substance of choice, according to a press release by the Caron Treatment Centers, which owns the Hanley Center.
“Older adults face a distinct set of changes and challenges as they enter their golden years,” said Dr. Barbara Krantz, Medical Director of Hanley Center. “This transitional period of life is challenging, and may lead to difficulty in dealing with stressful situations, such as an early retirement or new financial strains, which in turn may lead to serious anxiety and depression. Without the proper tools to manage their emotions, baby boomers and seniors may turn to quick fixes such as alcohol and drugs, creating the perfect storm for dependency.” Treatment admissions doubled in adults age 50 and over between 1992 and 2008, according to the Substance Abuse and Mental Health Services Administration. The Miami Herald reports that senior adult admissions in centers such as Hanley for prescription drug abuse have jumped 450 percent since 2000. Unintentional overdose is the second leading injury-related cause of death among seniors, the article notes.

The elderly often suffer from memory loss, mild cognitive impairment or Alzheimers, leading them to take too much medication, mix incompatible medications, or forget to take them. If they drink alcohol and take medication, the combination can be dangerous.
Teen Use of Ecstasy and Speed Linked With Developing Depression

A new study links teenagers’ use of Ecstasy and speed (methamphetamine and/or amphetamine) with a higher risk of developing depression. The study did not prove the drugs caused depression, according to HealthDay. The study of almost 3,900 10th graders in Quebec found that, compared with teens who didn’t use the drugs, those who said they used either speed or Ecstasy had a 60 to 70 percent increased risk of showing signs of depression a year later. Those who had tried both speed and Ecstasy had twice the risk for developing depressive symptoms, the researchers report. They note the drugs could have an effect on hormone levels involved in mood control. It is also possible that those who use the drugs are influenced by other users who have their own issues and mood problems. “Our findings are consistent with other human and animal studies that suggest long-term negative influences of synthetic drug use,” co-author Frédéric N. Brière of the University of Montreal said in a news release. The study is scheduled to appear in the Journal of Epidemiology and Community Health.
Understanding the Marijuana Withdrawal Syndrome

For many years now, addiction professionals have proclaimed of a noticeable syndrome developing with users who suddenly stop smoking marijuana. A hallmark phenomenon that occurs with the use of powerful stimulant and depressant drugs, withdrawal syndrome is an uncomfortable and often painful experience that results from extended, chronic administration of a drug. Typically a withdrawal syndrome presents with symptoms that appear to be the exact opposite of an abused drug's direct effects. Until recently, DSM-IV failed to include marijuana withdrawal as a syndrome worthy of diagnosis and treatment. But the National Epidemiologic Survey on Alcohol and Related Conditions examined a group of over 1100 regular marijuana users who did not binge drink or regularly use other drugs or narcotics. The respondents in the survey pointed to a marked set of symptoms that were experienced when they suddenly stopped the consumption of marijuana, the symptoms immediately resolved when marijuana use was restarted [1]. Withdrawal and abstinence syndrome symptoms are attributed to the action that THC and other cannabinoids have on sensitive receptors in the mid-brain. Cannabinoid receptors and relevant transmitters are not entirely understood but are known to influence serotonin, dopamine, acetylcholine and GABA in the brain.

Respondents to the marijuana withdrawal syndromes survey represented 44% of all those who admitted to regular use of marijuana. Those who responded to the survey reported three or more symptoms of cannabis withdrawal syndrome. Two types of withdrawal symptoms emerged in the survey: somatic and psychological. Somatic-related symptoms of withdrawal included weakness, psychomotor retardation and sleep disturbances. Psychological symptoms included depression, hyper anxiety and panic disorder. Respondents who experienced personality disorders concurrent to the use of cannabis found that the underlying personality problem was exacerbated and more pronounced upon withdrawal from marijuana.

This study points to the difficulties that a substantial number of marijuana users have in trying to stop using the drug and/or in maintaining periods of sobriety or non-use. Not all marijuana users experience this syndrome when they try to quit, but this survey reveals that a very substantial minority does have to weather the symptoms and discomfort. Motivated addicts may find it very difficult to stop marijuana use and may need pharmacologic assistance in completing the task. Additionally, the research indicates that people seeking to stop marijuana abuse may switch to other drugs of abuse to ease the discomfort and pain of withdrawal. Authors and experts associated with this study argue for cannabis withdrawal syndrome inclusion in DSM-V.

For community corrections and rehabilitation professionals, marijuana abuse is no laughing matter. Ignoring use and abuse of marijuana as nothing more than a harmless vice is unwise, especially in light of still increasing purity in THC concentration of commercial grade marijuana sold on the street. Prior essays in the MEDTOX Journal have cast light on the profound effects that cannabis use has on the anatomy of the brain and the functioning of the limbic system. Marijuana abuse should be taken seriously by all professionals who work with those who smoke it. Efforts should be made to guide marijuana users to programs and experts who specialize in the treatment of that type of addiction and dependency.

U.S. Loss Due to Child Abuse and Neglect Is a Staggering $124 Billion
Knowledge of the link between child maltreatment and physical, behavioral, and emotional problems is widespread. But what hasn't been so transparent is the financial impact of child abuse and neglect. That is, until a recent study conducted by the Centers for Disease Control and Prevention (CDC). According to the CDC report, the total lifetime estimated financial costs associated with one year of confirmed cases of child maltreatment is approximately $124 billion. This estimated figure is based on:
• childhood health-care costs
• adult medical costs
• productivity losses
• criminal justice costs
• special education costs

"Federal, state, and local public health agencies as well as policymakers must advance the awareness of the lifetime economic impact of child maltreatment and take immediate action with the same momentum and intensity dedicated to other high profile public health problems -- in order to save lives, protect the public's health, and save money," said Dr. Degutis, director of the CDC's National Center for Injury Prevention and Control.
FDA Issues Warning on Children’s Accidental Exposure to Fentanyl Pain Patches

The Food and Drug Administration (FDA) has issued a safety alert about fentanyl painkiller patches, warning that young children are at risk of death if they are accidentally exposed to the patches. The FDA said a majority of the 26 cases of accidental exposure to the patches since 1997 have involved children below the age of 2, Reuters reports.

Fentanyl is sold under the brand name Duragesic, and is also available as a generic product, according to the FDA. Fentanyl is a powerful opioid pain reliever. It releases the medication over the course of three days. If a child swallows the patch or applies it to his or her skin, it can cause death, by slowing breathing and raising carbon dioxide levels in the blood. A partially detached patch worn by an adult holding an infant could end up becoming attached to the child, the FDA notes. Toddlers can find lost, discarded or improperly stored patches and swallow them or stick them on themselves, thinking they are a sticker or bandage. Fentantyl patch users should keep them in a secure location that is out of children’s sight and reach, the FDA advises. Cover the patch with adhesive film so it does not come off, and check throughout the day to ensure it is still in place.

To dispose of a patch, fold it in half with the sticky sides meeting, and flush it down the toilet. Do not put patches in the household trash, where they can be found by children or pets.
“FDA recognizes that there are environmental concerns about flushing medicines down the toilet,” the agency said on its website. “However, FDA believes that the risk associated with accidental exposure to this strong narcotic medicine outweighs any potential risk associated with disposal by flushing.”
Commentary: Teen Alcohol Use — Parents Have More Influence Than They Think

Underage drinking is in part a youth problem, but it’s also an adult issue. Over half of all high school age drinkers get their alcohol from an adult, according to SAMHSA’s National Survey on Drug Use and Health. Plus, half of those adults providing alcohol are parents or other family members. Although adults can be part of the underage drinking problem, they can also be part of the solution. About three-quarters of teens say parents are the biggest influence on their decision on whether or not to drink.

Most parents want to do the right thing, but don’t know how. Part of that can be knowledge – one out of every five teens binge drink, but only one out of every 100 parents think their teen binge drinks. Sometimes parents take an authoritarian style of parenting that causes them to lose their ability to influence their teen through reason. While others take a hands-off approach, or allow their teen to drink under their supervision, which makes it even more likely that their teen will drink more when away from their parents.

Fortunately, Mothers Against Drunk Driving (MADD) has teamed up with Dr. Robert Turrisi of Pennsylvania State University to create the Power of Parents handbook. Based on Dr. Turrisi’s research, this handbook gives proven tips on how to talk with your teens about alcohol in a productive, positive way. Parents who read the handbook and have the intentional conversation with their teens about alcohol can reduce underage drinking behaviors by as much as 30 percent. We encourage you to start the conversation this Saturday, April 21st, PowerTalk 21 day — the national day for parents to start talking with their kids about alcohol.

Here are some tips from Dr. Turrisi’s research:
  1. Communicate before a problem starts. It’s important to have discussions before incidents happen – prior to any blaming, anger, or punishment.
  2. Discuss rules and consequences. Explaining how and why you expect your teen to behave, should allow for rational discussion of a sometimes emotional issue. Still, it’s important to impart that you don’t want your teen drinking. Discuss and agree on consequences of broken rules.
  3. Show you care. Sometimes a gentle touch can help show affection for your teen during this tough conversation. Telling your teen you love them and want them to be healthy and safe is the reason why it’s important to talk about the dangers of underage drinking together.
  4. Pay attention. Even when life is stressful, it’s important to make time to listen to your teen, know where your teen is and what your teen is doing.
  5. Share family activities, including events such as dinner, to build a bond with your teen.
  6. Give and get respect. When your teen talks to you, it’s important to listen and reply respectfully, and to insist your teen do likewise.
  7. Enforce consequences consistently. If your teen breaks the rules, stay calm and enforce the consequences you’ve agreed upon.
Jan Withers, MADD National President
If Gambling, Games, and Sex Are Addictive, What Is Addiction?

By Stanton Peele, Addiction expert

DSM 5's announcement that the psychiatric diagnostic manual will, for the first time, call something addictive that doesn't involve substance abuse -- gambling -- has opened the floodgates. It is intriguing to consider how gambling was placed in this category, since there isn't an "addiction" task force for DSM 5, only a substance-related-disorders one. So who decided gambling was the one thing people did, other than to consume drugs and alcohol, that was addictive and how did they decide that?

Charles O'Brien, M.D., a leading "addiction = chronic-brain-disease" proponent and chair of the substance-disorders group, announced the inclusion of gambling because "pathological gambling and substance-use disorders are very similar in the way they affect the brain and neurological reward system." Thus it seems O'Brien, rather than the task force of consulting substance abuse specialists, perhaps in league with colleagues at the pinnacle of the "addiction = chronic-brain-disease" movement (like Nora Volkow), spearheaded the adoption of this position.
Where does that leave all the other candidates for inclusion in the addiction category -- leading entries for which are sex and games? For them to be included, will they also have to be "shown" to affect the same "brain and neurological reward system" as drugs and gambling? Is there any powerful experience that does not affect this system? Did O'Brien really scrutinize reams of PET scans of gamblers to find that their reward systems were impacted in the same addictive way as cocaine and alcohol abusers?

I ask because an awful lot of people claim that they are, or have been, addicted to games or to sex. Are they crazy? Didn't we discover gambling was addictive because people gave heartfelt testimony that they were addicted to gambling? Are they right while the people who claim to be addicted to games and sex are just deluded slackers?

A sensible person who is asked, "Are gambling, sex, and games addictive?" will answer, "Anything can be addictive, or not, depending on how engrossed people become in them, and how much they are damaged by it." In other words, it isn't which activities we focus on and call addictive, it is how the person engages in the experience (compulsively, unable to halt or to cut back, in ways that interfere with their functioning and that harm them) that counts.
Think about OCD and its diagnosis. Do we really care what people obsess or behave compulsively around? If a person endlessly organizes shoes, or washes his or her hands repeatedly, or locks and unlocks the door ad infinitum -- the thing they obsess over and behave compulsively towards is not really the matter. It is the pattern of behavior they engage in and its consequences for them.

Same with addiction.

Is this view of addiction "scientific"? It is actually more so than claiming -- without adequate evidence -- that a wide variety of behaviors are all traceable to some posited brain or neurochemical mechanism defined broadly enough to envelop such biologically diverse activity.

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