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Friday, May 24, 2013

ATOD and Advocacy Update - Week-Ending May 24, 2013

Doctor warns 'smoking' alcohol is risky proposition
Doctors are warning that a new and trendy way to get a buzz is really dangerous: Some people are choosing to "smoke" their alcohol instead of drinking it. Read more here.

Study: College Women Binge Drink More Often Than Men
Female college students exceed government-suggested limits on weekly alcohol consumption more often than male students do, according to a new report by researchers at Harvard University. Click here for more.

DSM-IV Boss Presses Attack on New Revision
A new edition of psychiatry's diagnostic guide "will probably lead to substantial false-positive rates and unnecessary treatment," charged the man who led development of the last version. To be released at the American Psychiatric Association's annual meeting, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, "introduce[s] several high-prevalence diagnoses at the fuzzy boundary with normality," according to Allen Frances, MD, who chaired the task force responsible for DSM-IV issued in 1994. Frances, now an emeritus professor at Duke University, wrote online in Annals of Internal Medicine that changes from DSM-IV will apply disease labels to individuals who may be unhappy or offensive but still normal. Such individuals would include those experiencing "the forgetfulness of old age" as well as children with severe, chronic temper tantrums and individuals with physical symptoms with no medical explanation. Read the rest of this story here.

Study Finds That 14% of Undergraduate Students at a Southeastern University  Report Synthetic Cannabinoid Use; Users More Likely to Be Male and Identify as LGBT
Synthetic cannabinoid use among college students at a Southeastern university is concentrated in males and in the lesbian, gay, bisexual, or transgender (LGBT) community, according to the first known study to obtain a detailed profile of users of any type of synthetic cannabinoid. Overall, 14% of undergraduate students reported lifetime use of synthetic cannabinoids, with an average initiation age of 18. Males were twice as likely as females (19% vs. 9%) to report synthetic cannabinoid use. Sexual orientation was also found to be related to synthetic cannabinoid use. Students who self-identified themselves as LGBT were nearly twice as likely as heterosexual students (27% vs. 14%) to report lifetime use (see figure below), and reported use was equally high among both male and female LGBT students. The study also found that lifetime use of synthetic cannabinoids was virtually non-existent among those who did not report past month alcohol (0.3%) or marijuana (0.4%) use, compared to 16% and 24%, respectively, of past month users of these substances. According to the authors, “future research should investigate the higher use among [LGBT individuals], and prevention efforts may be most effective when reaching out to the LGBT community”.  Editor’s Note: It is impossible to determine the types of synthetic cannabinoids contained in synthetic marijuana products without specific testing—studies have shown that the types and amounts of synthetic cannabinoids can vary greatly between products, lots, and even within the same package1. In reality, youth who report using synthetic marijuana likely have no idea what specific synthetic cannabinoid they are using or what the effects will be. SOURCE:  Adapted by CESAR from Stogner, J.M. and Miller, B.L., “A Spicy Kind of High: A Profile of Synthetic Cannabinoid Users,” Journal of Substance Use.”

Survey Finds People in Recovery Experience Striking Improvements Over Time
The first nationwide survey of people in recovery from addiction to alcohol and drugs finds their lives steadily improve in areas from employment to family life to community involvement. The online survey, released by the advocacy group Faces & Voices of Recovery, attempts to measure and quantify the effects of recovery over time. Continue reading here.

Many Parents Don’t Know Their Teens Use ADHD Drugs for Studying
Many parents are not aware that their teenage children abuse "study drugs," a new poll suggests. In the poll, just 1 percent of parents said their teenage children had taken drugs such as Adderall or Ritalin without a prescription. That is much lower than the percentage of teens that surveys suggest are using the drugs. For example, a 2012 study of high schoolers found that about 10 percent of sophomores and 12 percent of seniors said they had used the drugs without a prescription. Continue here.

Starting to Drink at Younger Age Linked With Heavier Drinking Later in Life
The earlier a person starts drinking, the greater the chance he or she will consume more alcohol later in life, according to a new study of humans and rats. People who start drinking during puberty consume more alcohol later in life than those who start drinking later. Science Daily reports researchers in Germany studied 283 young adults, and asked them when they first started drinking. Their drinking behavior—the number of days they drank, the amount of alcohol they consumed, and whether their drinking was considered hazardous—was assessed at ages 19, 22 and 23. The researchers also studied the effects of early alcohol exposure on drinking patterns later in life in 20 rats. The researchers found people who had their first drink during puberty had elevated drinking levels compared with those who started drinking at a later age. The animal study found that rats receiving free access to alcohol during puberty consumed more alcohol as adults, compared with animals that first came into contact with alcohol during adulthood. The results are published in Alcoholism: Clinical & Experimental Research. In a news release, lead researcher Miriam Schneider explained why the study included both humans and animals. “Adolescents have their first drink at very different ages,” she said. “It would be unethical to make adolescents have their first drink in the course of a study, so this variable requires a longitudinal epidemiological study or experimental animal research to assess drinking behavior.” She added, “Puberty is a very critical developmental period due to ongoing neurodevelopmental processes in the brain. It is exactly during puberty that substances like drugs of abuse — alcohol, cannabis, etc. — may induce the most destructive and also persistent effects on the still developing brain, which may in some cases even result in neuropsychiatric disorders, such as schizophrenia or addictive disorders.”

The Search for Mental Illness and Addiction in the Brain, Part II: Why Are the Human Psyche and Behavior So Complicated?
Let's return to those halcyon, simple-minded years, the late 1970s, when everything seemed possible in biologizing human behavior. In 1979, for instance, psychologist Thomas Bouchard and his colleagues at the University of Minnesota began their study of twins reared apart. Bouchard's chief conclusion based on that research: "The determinants of personality are mostly genetic." But that conclusion wasn't what really attracted the attention of the media. Bouchard regularly publicized remarkable similarities he found among his subjects, including this one: "Bridget and Dorothy met for the first time to make the flight from England to Minneapolis. These two strangers each wore seven rings and multiple bracelets on each wrist." Other accounts noted that the multiple rings each sister wore were deployed on the same fingers. Critic Leon Kamin, a Princeton psychologist who found traits such as "beringedness" impossible to believe, surmised that the sisters consulted about their jewelry beforehand. In any case, we no longer hear about such genetic matching on seemingly random human traits as those Bouchard uncovered. That's because inheritance of such traits makes no sense based on what we've discovered about how the genome actually operates. Continue reading here.

What is Comorbidity and What Are Its Causes?
When two disorders or illnesses occur simultaneously in the same person, they are called comorbid. Surveys show that drug abuse and other mental illnesses are often comorbid. Six out of ten people with a substance use disorder also suffer from another form of mental illness. But the high prevalence of these comorbidities does not mean that one condition caused the other, even if one appeared first. In fact, there are at least three scenarios that we should consider:

  1. Drug abuse can cause a mental illness.
  2. Mental illness can lead to drug abuse.
  3. Drug abuse and mental disorders are both caused by other common risk factors.
In reality, all three scenarios can contribute, in varying degrees, to the establishment of specific comorbid mental disorders and addiction. Continue reading about this latest NIH research here.

Many Medical Residents Give Poor Marks to Addiction Training
More than half of internal medicine residents at Massachusetts General Hospital in Boston say they were not adequately trained in addiction and other substance use disorders, according to a new survey. The survey, conducted last year, found residents rated their training in these areas as fair or poor, Health Canal reports. Many said they were not prepared to diagnose or treat addiction or substance use disorders. “Our residents estimated that one in four hospital inpatients has a substance use disorder, which matches what other studies have found and represents a disease prevalence similar to that of diabetes,” lead author Sarah Wakeman, MD said in a news release. “Finding that the majority of residents feel unprepared to treat addiction and rate the quality of their education so low represents a tremendous disparity between the burden of disease and the success of our current model of training.” Wakeman noted several previous studies have indicated a deficiency in addiction education for medical residents. Some programs offer no training in this area, she said. Massachusetts General Hospital says it has increased residents’ training in addiction medicine as a result of the findings. The survey, based on responses from 101 residents, is published in the journal Substance Abuse. One-quarter said they felt unprepared to diagnose addiction, and 62 percent said they felt unprepared to treat it. Only 13 percent felt very prepared to diagnose addiction, and no residents felt very prepared to treat addiction. Participants were asked six questions to evaluate their knowledge about diagnosing and treating substance abuse. None answered all the questions correctly. Only 6 percent correctly answered all three questions about medication treatment options for addiction.

Individuals Who Drink Heavily and Smoke May Show 'Early Aging' of the Brain
Treatment for alcohol use disorders works best if the patient actively understands and incorporates the interventions provided in the clinic. Multiple factors can influence both the type and degree of neurocognitive abnormalities found during early abstinence, including chronic cigarette smoking and increasing age. A new study is the first to look at the interactive effects of smoking status and age on neurocognition in treatment-seeking alcohol dependent (AD) individuals. Findings show that AD individuals who currently smoke show more problems with memory, ability to think quickly and efficiently, and problem-solving skills than those who don't smoke, effects which seem to become exacerbated with age. The rest of this article is here.

Law Passed Banning Drug That Caused Kendall Park Man to Eat Grass
A bill that criminalizes the manufacture, sale and possession of synthetic marijuana was signed into law Monday by Gov. Chris Christie. The possession of fake pot will now carry real charges after a bill banning the manufacture, sale and possession of synthetic marijuana was signed into law Monday by Gov. Chris Christie. Under the law, producing and selling one or more ounces of synthetic marijuana is now a second-degree crime, and producing or selling less than an ounce is a third-degree crime. The bill also established third- and fourth-degree crimes for possession of synthetic marijuana. Last year, Attorney General Jeffrey S. Chiesa announced a statewide ban on the manufacture, distribution, sale, and possession of any of the hundreds of chemicals designed to mimic the effects of marijuana, commonly called “synthetic marijuana,” “K2,” or “Spice.” The Attorney General said the number of synthetic marijuana exposures that were reported to poison control centers increased by 139 percent nationwide, and by 711 percent in New Jersey alone between 2010 and 2011. Of the reported cases in New Jersey, 92 percent resulted in symptoms that required treatment in a healthcare facility. 

Choices in recovery support groups continue to emerge
Signs can be found everywhere in many places to demonstrate that support groups taking an alternative approach to the 12-Step philosophy have arrived as a critical component of the recovery community. Looking alone at arguably the most prominent of these groups nationally, SMART Recovery, these developments serve among the telling examples of the growth of 12-Step alternatives. While most prominent in a few pockets of the U.S. (particularly San Diego, New York City and across Massachusetts) and overseas mainly in the United Kingdom and Australia, regularly meeting SMART Recovery groups likely will number 1,000 worldwide at some point this year.

Anti-drug messages miss mark with the young
Former Boston Celtic and Boston College basketball star Chris Herren kicked off the 2013 National Association of Addiction Treatment Providers (NAATP) Conference in San Antonio with a moving story of his 14-year battle to overcome substance abuse. It was a battle that he was losing for more than a decade until a series of angels — health professionals, hometown friends, law enforcement, even fellow homeless men — pointed him in the right direction long enough to enable another NBA player and one-time teammate Chris Mullen, to step in and pay for months of addiction treatment that Herren couldn’t afford. Continue reading here.

Center uses technology to help patients during and after treatment
One of the principles of behavioral health recovery management is the application of new technology to the work being done for addiction treatment and ongoing recovery support. In some ways this comes as no surprise. After all, what we now think of as “treatment as usual” contains approaches that originally were groundbreaking or innovative.  Rest of this story is here.

More than one in five parents believe they have little influence in preventing teens from using illicit substances
In fact, parents are among the most influential factors in preventing children’s substance use. A new report indicates that more than one in five parents of teens aged 12 to 17 (22.3 percent) think what they say has little influence on whether or not their child uses illicit substances, tobacco, or alcohol. This report by the Substance Abuse and Mental Health Services Administration (SAMHSA) also shows one in ten parents said they did not talk to their teens about the dangers of using tobacco, alcohol, or other drugs even though 67.6 percent of these parents who had not spoken to their children thought they would influence whether their child uses drugs if they spoke to them. In fact national surveys of teens ages 12 to 17 show that teens who believe their parents would strongly disapprove of their substance use were less likely to use substances than other. For example, current marijuana use was less prevalent among youth who believed their parents would strongly disapprove of their trying marijuana once or twice than among youth who did not perceive this level of disapproval (5.0 percent vs. 31.5 percent).  The SAMHSA report, "1 in 5 Parents Think What They Say Has Little Impact on Their Child’s Substance Use," is available at It is based on the findings of SAMHSA’s National Survey on Drug Use and Health -- an annual nationwide survey of 67,500 Americans aged 12 or older.

NJ crackdown on bars switching out booze finds 1 sold rubbing alcohol with caramel as scotch
At one bar, a mixture that included rubbing alcohol and caramel coloring was sold as scotch. In another, premium liquor bottles were refilled with water — and apparently not even clean water at that. State officials provided those new details Thursday on raids they conducted a day earlier as part of a yearlong investigation dubbed Operation Swill. Twenty-nine New Jersey bars and restaurants, including 13 TGI Fridays, were accused of substituting cheap booze — or worse — for the good stuff while charging premium prices. Read more here.

Friday, May 17, 2013

ATOD and Advocacy Update - Week-Ending May 17, 2013

Heroin Addiction Takes Toll in Suburban New Jersey
New Jersey officials report a rise in heroin addiction, drug-related crime and deaths among young people in suburbs. Many became addicted to prescription painkillers, and switched to heroin because it is cheaper, potent and widely available, according to The Record of Woodland Park. The growth of heroin use among young people in the suburbs is being seen nationwide. According to the 2011 National Survey on Drug Use and Health, the number of people who were past-year heroin users in 2011 (620,000) was higher than the number in 2007 (373,000). New Jersey is a center of heroin use in part because of its ports and highways, which are conduits for South American heroin, the article notes. Heroin found on New Jersey streets today is at least five times more pure than it was several decades ago, law enforcement officials say. The increased potency leads to quicker addiction, they add. “Heroin is much more commonplace than it’s been in years,” Ellen Elias, Director of the Center for Alcohol and Drug Resources in Hackensack, told the newspaper. “We see it all around. It seems like the population in which heroin is most prevalent is that 18- to 25-year-old population.” Police in Bergen County, in northern New Jersey, report increases in shoplifting, home invasions, burglaries and armed robberies, by people addicted to heroin who are seeking money to buy drugs. Last week, New Jersey Governor Chris Christie signed into law a measure that encourages people to report drug overdoses. The law allows people to call 911 to report a drug overdose, without the fear of getting arrested for drug possession themselves.

Youth drinking cultures, social networking and alcohol marketing
Preventing alcohol abuse, especially among young people, has long been a focus of public-health campaigns. But despite the well-publicised social and medical consequences of drinking too much it's clear that for many, heavy drinking has become a normal part of life.  And now, public-health professionals have a new force to contend with in their battle against the bottle: social-networking sites (SNS). Writing in a recent issue of Critical Public Heath, researchers from New Zealand consider the extensive, and not entirely positive, impact SNS may have on their efforts to encourage more responsible youth drinking (McCreanor et al., 2013). The authors argue that although SNS users benefit from creating and sharing content, the sites are "quintessentially commercial platforms" which provide entirely new vehicles for alcohol marketing. The very characteristics that make SNS popular – blurring boundaries between public and private spaces, acting as extensions of face-to-face relationships and being regularly viewed and updated – also contribute to their commercial potential by bringing alcohol producers and consumers closer together. The researchers note that site owners also have extensive access to valuable information about users' preferences, habits and interests, providing a bonanza for alcohol-marketing dataminers. Evidence suggests that alcohol producers and sellers are already embracing SNS as an effective marketing tool. Diageo, which has expanded its SNS marketing in recent years, has entered into a deal with Facebook, with over one billion users; other UK brands also employ a range of strategies including games, competitions and "branded conversation stimulus" in Tweets and wall posts. Well-known brands and alcohol-related events generate vast numbers of "friends", and alcohol-related apps thrive. The effect of all of this, the authors write, is to "normalise alcohol within both banal and special occasions in the everyday lives of SNS users". And then there is user-generated content. Millions of wall posts, profiles and photos revolving around alcohol play a big role in normalising drinking within young adults' lives and cultural words. But the biggest challenge posed by SNS is that "they are effectively beyond the domain of public authority, essentially unregulated and possibly uncontrollable". The authors call for more research into the impact of SNS on youth drinking patterns, as even this initial survey gives a strong indication of how they may come to play a major role in maintaining pro-alcohol environments. On the positive side, the Critical Public Health study also points out that SNS can be used to encourage young drinkers to change their practices in a more positive way. Unfortunately for public-health practitioners however, photos of people drinking responsibly aren't nearly so much fun to put up on Facebook.

 Pregnant Teens in Substance Abuse Treatment Face Many Challenges
Pregnant teens, who are more likely than pregnant adults to face medical issues, face a host of additional challenges if they are also being treated for substance abuse, a new government report finds. The Substance Abuse and Mental Health Services Administration (SAMHSA) found pregnant teens being treated for substance abuse were three times more likely than other female teens in treatment to receive public assistance as their main source of income—15 percent versus 5.3 percent). The report also found 74 percent of non-pregnant female teens in treatment who were not working were students, compared with just 44.2 percent of pregnant teens treated for substance abuse. Half of pregnant teens in treatment used drugs or alcohol in the month before they started treatment, HealthDay reports. Almost one-fifth used drugs or alcohol daily during that month. The report notes that when mothers use drugs during pregnancy, their babies can show signs of addiction at birth. Long-term effects of a mother’s prenatal drug use have been observed in children at 6 years of age. Marijuana was the most commonly used substance among female teens in treatment programs. The report found 73 percent of pregnant teens and 70 percent of non-pregnant teens used the drug. Pregnant teens were twice as likely to use methamphetamines and amphetamines, compared with other female teens—17 percent versus 8 percent. Overall, pregnant teens make up about 4 percent of the 57,000 females ages 12 to 19 admitted to substance abuse treatment programs annually, according to SAMHSA.

Children of Addicted Parents More Likely to be Depressed in Adulthood
Children whose parents are addicted to drugs or alcohol are more likely to be depressed as adults, a new study suggests. In a study of 6,268 adults, University of Toronto researchers studied the relationship between parental addiction and their children’s depression in adulthood. They found 312 participants had a major depressive episode in the previous year, and 877 said when they were under the age of 18, at least one parent drank or used drugs often enough to cause problems for the family. After taking into account factors such as childhood maltreatment, parental unemployment and adult smoking and drinking, the researchers found adults exposed to parental addiction had a 69 percent higher risk of depression, compared to their peers with non-addicted parents, Science Daily reports. The study did not establish what might cause the relationship between a parent’s addiction and adult depression. “It is possible that the prolonged and inescapable strain of parental addictions may permanently alter the way these children’s bodies react to stress throughout their life,” co-author Robyn Katz said in a news release. “One important avenue for future research is to investigate potential dysfunctions in cortisol production–the hormone that prepares us for ‘fight or flight’–which may influence the later development of depression.” Lead researcher Esme Fuller-Thomson said the study reinforces the need to develop interventions that support healthy childhood development. “As an important first step, children who experience toxic stress at home can be greatly helped by the stable involvement of caring adults, including grandparents, teachers, coaches, neighbors and social workers. Although more research is needed to determine if access to a responsive and loving adult decreases the likelihood of adult depression among children exposed to parental addictions, we do know that these caring relationships promote healthy development and buffer stress.” The study is published in Psychiatry Research.

Can Facebook be used to find young alcoholics?
Local researchers are scanning college students’ social media sites to identify which will become alcoholics later in life. Staff at the Seattle Children's Research Institute have analyzed the Facebook profiles of college freshman and found the majority of those who were alcohol dependent left clues of their drinking problem on social media. Continue reading here.

FDA Denies Request from Opana ER Maker to Block Generic Forms of the Drug
The Food and Drug Administration (FDA) on Friday denied a request from the maker of the painkiller Opana ER to block generic forms of the drug. The decision came as a surprise, Reuters reports. The drug’s manufacturer, Endo Health Solutions, argued its newer tamper-resistant formula was more difficult to abuse than the original version of the drug, and asked that the agency not approve generic forms of the earlier version. The FDA decided that since the original Opana had not been withdrawn for reasons of safety or effectiveness, generic forms of the painkiller could continue to be approved and marketed. The FDA also said the newer Opana ER could still be abused, and might be more easily injected than the original formulation. “We are extremely disappointed and disagree with today’s decision, and believe that the approval of non-abuse deterrent formulations of long acting opioids will contribute to a significant increase in prescription drug abuse,” Rajiv De Silva, President and Chief Executive Officer of Endo Health Solutions, said in a news release. Last month, the FDA announced it will not approve any generic versions of the original form of OxyContin. The move is aimed at preventing prescription drug abuse. The original version of OxyContin could be crushed and then snorted or injected. The FDA also approved new labeling for a reformulated version of the drug, which will indicate it is more difficult to crush, and thus harder to abuse than the original version. OxyContin’s manufacturer, Purdue Pharma, introduced the tamper-resistant formula in 2010. Because of the FDA’s decision about generic versions of OxyContin, many experts thought the agency would make a similar ruling about Opana ER, the article notes.

Colleges Work Together To Reduce Binge Drinking
Colleges that are part of a national program to reduce binge drinking among students say the first two years have been productive. More schools will join the initiative in June. According to the National Institute on Alcohol Abuse and Alcoholism, about four out of five college students drink alcohol, and about half of college students who drink, also consume alcohol through binge drinking. The Associated Press reports 32 colleges and universities are part of the National College Health Improvement Project, created by Dartmouth College in 2013. The program aims to help members measure their progress against binge drinking, and then share their strategies with other schools. “It’s been a really great source of collaborative learning and resources,” Annie Stevens, Associate Vice President for Student and Campus Life at the University of Vermont, told the AP. “It really does give you a chance to get out of your own bubble and look around and rely on your colleagues. We’re all struggling with the same thing and saying, ‘Hey, have you found anything you’re doing that seems to work?’” The University of Vermont has started sending emails to parents before big party weekends or events, asking them to talk with their children about high-risk drinking. The school is also working with police to identify off-campus housing that generates calls about troublesome parties. “So instead of police going back and being called to that house several times, our staff can go and knock on doors and have a better conversation with students about, ‘Really? Do you want police showing up?’ or ‘What’s happening on this street or in this neighborhood?’” Stevens said. Any time a student goes to the University of Vermont campus health clinic, they are asked about their alcohol use. A doctor becomes involved if any of the answers raise a red flag, according to Stevens.

Modern Etiquette: When a colleague is abusing alcohol
The lovely dinner meeting with my colleague turned out to be a bad dream. Sure, we had wine with the meal. I loved every moment, morsel, and drop of it. Yet I was poorly prepared when she not only had wine, but slugged down cognac afterward, and commented that she had preceded our meeting with "a couple of scotches." I ended up taking her car keys and checking her into the hotel that housed the restaurant where we dined. It all seemed like a dramatic hassle - and then I realized it wasn't over. I had to face this woman again. And what would I say when I did? It can be a painful experience to watch an associate or friend behave badly after having one too many at a business function or the local watering hole. So I turned to Todd Whitmer, senior executive officer of the Caron Foundation, a nationally recognized U.S. non-profit addiction treatment center, for advice on how to help my colleague avoid alcohol-related career suicide - or worse. Talk About How Their Actions Made You Feel. Continue reading here.

Doctors Should Ask and Counsel Adult Patients About Drinking, Report Advises
Primary care physicians should ask their adult patients about their drinking habits, and counsel those whose alcohol use is risky, according to a new report. The U.S. Preventive Services Task Force made their recommendation based on a review of studies. They found there is sufficient evidence to conclude screening can accurately detect alcohol misuse, and counseling can reduce heavy drinking in adults, Reuters reports. The task force is an independent panel of experts in prevention and evidence-based medicine. “When people misuse alcohol, there can be serious consequences for themselves, their families, and their communities,” Task Force member Sue Curry, PhD, noted in a statement. “Alcohol misuse is the cause of tens of thousands of deaths per year in the United States—deaths that could have been prevented. The good news is that primary care professionals can identify adults who engage in risky or hazardous drinking and through brief counseling, help them drink more responsibly.” She added, “Unfortunately, risky and hazardous drinking is also a serious problem among adolescents, but we don’t know how to identify teens who may be engaging in risky or hazardous drinking, and we don’t know if brief counseling is effective in helping them to stop. We recognize the critical need for more research on what primary care teams can do to help keep teens safe and sober.” The National Institute on Alcohol Abuse and Alcoholism defines risky drinking as having more than four drinks in one day or 14 drinks in one week for men, and more than three drinks daily or seven per week for women. About one-third of adults misuse alcohol in the United States, according to the article.

How Do You Make A Painkiller Addiction-Proof?
For those who have severe chronic pain, the advantage of OxyContin over other prescription painkillers is that it lasts for 12 hours. For those who like to get high on opioids, the great thing about OxyContin is that if you crush it and snort it, or mix it with water and inject it, you get 12 hours' worth of oxycodone all at once. "So basically they get a really big high," Bob Jamison, a professor of anesthesiology at Brigham and Women's Hospital in Boston, tells Popular Science. Read the rest here.

Attorneys General Seek Warning Label Cautioning Pregnant Women Against Using Pain Pills
Forty-three state attorneys general are calling for new “black box” warning labels on prescription painkillers that can harm unborn children. In a letter sent Monday to the U.S. Food and Drug Administration, the attorneys general point to an alarming spike in the number of babies born with “neonatal abstinence syndrome,” or drug withdrawal symptoms experienced by babies when they are cut off from the opioid drugs ingested by their mothers. The symptoms include tremors, seizures, poor weight gain and fever. Continue reading here.

Prescription Drug Monitoring Programs Show Promise at Curbing Abuse, but Need Improvement
Prescription drug monitoring programs (PDMPs) have been established in most U.S. states to track prescriptions of opioid analgesics, sedatives, and amphetamine-type stimulants. Abuse of such drugs—especially opioids—has reached epidemic proportions, and PDMPs have the potential to help authorities monitor and curb diversion through illegal practices like “doctor shopping,” prescription forgery, and theft. Such programs are also increasingly being used by doctors to improve patient care. But according to the authors of a new review in Health Affairs, programs vary widely in their design, function, and who has access to data, and although there is some evidence PDMPs are beneficial, their overall impact remains unclear. To better realize the promise of PDMPs, the authors recommend greater interstate cooperation and standardization among programs, making programs proactive by issuing routine reports of suspicious activity even if unsolicited, educating providers about effective PDMP use, better integrating such programs into the workflow of clinicians, and increasing funding support. Source: NIH.

DSM-5: The End of One-Size-Fits-All Addiction Treatment?
Sometime this month, the DSM-5 will replace the DSM-IV as the coin of the realm for diagnosis of mental illnesses, including substance use disorders. Despite the unprecedented criticism that has accompanied the process, the final product’s changes are based on very solid epidemiological research, and they are likely to reduce ambiguity and confusion. But there may be some surprise, too, as received wisdom about the diagnosis and treatment of addiction is turned on its head. Let’s hope that this development will result in a more rational and nuanced approach to addiction. Read the rest of this article here.

NTSB recommends lowering blood alcohol level that constitutes drunk driving
The National Transportation Safety Board voted to recommend to states that they lower the blood-alcohol content that constitutes drunk driving. Currently, all 50 states have set a BAC level of .08, reflecting the percentage of alcohol, by volume, in the blood. If a driver is found to have a BAC level of .08 or above, he or she is subject to arrest and prosecution.   The NTSB recommends dropping that to a BAC level of .05.  See more here.

And here’s the fallout….
Beverage group rips 'ludicrous' call from NTSB for lowered blood alcohol limit
Beverage companies are pushing back on the National Transportation Safety Board's (NTSB) call for lowering the blood alcohol limit for drivers.  The NTSB on Tuesday recommended lowering the legal blood alcohol limit for drivers from 0.08 percent to 0.05 percent. The guidance from the five-member board is not binding, but will be sent to state governments for consideration. The American Beverage Institute panned the recommendation, calling it "ludicrous." Read the rest here.

And, a New York Times Opinion Section called “Room for Debate”

Too Drunk to Drive…read all of the posted opinions at

Task Force Recommends Screening All Adults for Alcohol Misuse
Questions about alcohol use should be a part of regular physical checkups, according to a panel of experts. About 21% of American adults admit that they engage in risky drinking behaviors, from overindulging, which can lead to physical and mental harm, to alcohol dependence. And it remains the third leading cause of preventable death in the U.S. So in an effort to address the risk, a government-backed advisory panel–the U.S. Preventive Services Task Force (USPSTF)–reviewed the existing data to determine whether more rigorous screening could identify and intervene in more cases of potential alcohol abuse. Read the rest of this article here.

Teens’ Use of Smokeless Tobacco Holds Steady, Study Finds
Teens’ use of smokeless tobacco products has held steady since 2000, at about 5 percent, a new study finds. Researchers at the Harvard School of Public Health compared data from the 2000 and 2011 U.S. National Youth Tobacco Survey, according to HealthDay. The 2000 survey included almost 36,000 students, while the 2011 survey included about 19,000. They were asked if they used smokeless tobacco products such as chewing or dipping tobacco or snuff for at least one day within the past month. The study found a decrease in use of smokeless tobacco among 9- to 14-year-olds, but an increase among those ages 15 to 17, the researchers report in the Journal of the American Medical Association. The researchers noted the relatively low cost of smokeless tobacco, compared with cigarettes, might make the products more attractive to young people. “The use of modified traditional smokeless tobacco products, such as moist snuff, coupled with lower taxes on smokeless tobacco products [vs. cigarettes] may have contributed to the stable prevalence of smokeless tobacco” at the same time that cigarette smoking has decreased among teens, they wrote. Under the Family Smoking Prevention & Tobacco Control Act, signed into law in 2009, smokeless tobacco product packages and ads must contain one of four required warnings: the product can cause mouth cancer, the product can cause gum disease and tooth loss, the product is not a safe alternative to cigarettes, and smokeless tobacco is addictive.

Study Links PTSD and Brain Receptors Activated by Marijuana
A new study finds a connection between post-traumatic stress disorder (PTSD) and the number of cannabinoid receptors in the brain. These receptors, called CB1, are activated when a person uses marijuana. Researchers at New York University Langone Medical Center used brain imaging techniques to find the connection, Fox News reports. They say their findings could lead the way to new treatments for PTSD. “There’s not a single pharmacological treatment out there that has been developed specifically for PTSD,” lead author Dr. Alexander Neumeister said in a news release. “That’s a problem. There’s a consensus among clinicians that existing pharmaceutical treatments such as an antidepressant simply do not work.” The researchers decided to study CB1 receptors because many PTSD patients use marijuana in an attempt to relieve their symptoms, Dr. Neumeister said. Many say marijuana works better for them than legal medications. The study included 60 participants who had a PET scan. Some had PTSD, some had a history of trauma but not PTSD, and some had neither. All participants were injected with a radioactive tracer, which traveled to CB1 receptors in the brain, and illuminated them for the scan. The researchers found people with PTSD had higher levels of CB1 receptors in the parts of the brain associated with fear and anxiety, compared with participants without PTSD. They also had lower levels of a brain chemical that binds to CB1. When a person has lower levels of this chemical, anandamide, the brain compensates by increasing the number of CB1 receptors. Dr. Neumeister said a new PTSD treatment based on their research should not destroy CB1 receptors, because this could lead to depression. Instead, he is working on a treatment that would restore a normal balance of the endocannibinoids in the brains of people with PTSD. Endocannabinoids are substances that activate cannabinoid receptors. He said this compound does not cause health problems seen in people who are chronic marijuana users. He hopes to start clinical trials of the medication soon. The findings are published in the journal Molecular Psychiatry.

Heroin Making a Comeback in Florida as “Pill Mills” Shut Down
Florida officials say heroin is making a comeback, now that the state has had success in shutting down “pill mills” selling prescription painkillers. Heroin is appearing in urban areas and smaller communities, according to Jim Hall of Nova Southeastern University’s Center for Applied Research on Substance Abuse and Health Disparities. “Young adults, 18 to 30, white, prescription opioid addicts are making the transition to heroin,” he told The Miami Herald. Officials are responding in a number of ways, including a public education campaign about the risks of heroin and needle injection, and increasing awareness of a Good Samaritan law designed to prevent drug overdoses. Between July 2010 to June 2011, there were 45 heroin-related deaths in Florida, compared with 77 in the same time period a year later. In Broward County, which includes Fort Lauderdale, addiction treatment centers report an 87 percent increase in admissions among people using heroin last year, from 169 to 316. Miami-Dade County reported an increase from 227 heroin admissions to 308 in the first half of last year. A study published in July 2012 found OxyContin abuse has decreased now that the painkiller has been reformulated to make it more difficult to misuse. Many people who abused the drug have switched to heroin, the researchers reported in the New England Journal of Medicine. In 2010, the company that makes OxyContin introduced a new version of the drug that is more difficult to inhale or inject. Florida has taken a number of measures in the past several years designed to reduce prescription drug abuse. In June 2011, Florida Governor Rick Scott signed into law a bill designed to cut down on prescription drug abuse by controlling pill mills in the state. The law authorized the creation of a prescription-drug monitoring database to reduce doctor-shopping by people looking to collect multiple painkiller prescriptions. The legislation also imposed new penalties for physicians who overprescribe medication and imposes stricter rules for operating pharmacies.

5 Myths about Addiction that Undermine Recovery
Honest, courageous and insightful aren’t words typically used to describe drug addicts. But if given the chance, many addicts end up developing these qualities and contributing to society in a way they never imagined possible. These successes occur in spite of major obstacles, from the ever-present threat of relapse to the pervasive stereotypes addicts encounter along the way. Even with three decades of myth-busting research behind us, some of the most damaging beliefs about addiction remain. Continue reading here.

Tenn. Hospital Treats Drug-Dependent Babies
He's less than two weeks old, but he shows the telltale signs of a baby agitated and in pain: an open sore on his chin where he's rubbed the skin raw, along with a scratch on his left check. He suffers from so many tremors that he's been placed in a special area so nurses can watch him around the clock in case he starts seizing —or worse, stops breathing. The baby is one of many infants born dependent on drugs. He is being treated at East Tennessee Children's Hospital in Knoxville, where doctors and nurses are on the front lines fighting the nation's prescription drug epidemic. Drug abuse in the state is ranked among the nation's highest, according to some estimates, a fact underscored by the number of children born with signs of drug dependence. Click here for more content.

Report: Lax Rules Allow Felons to Serve as Drug and Alcohol Counselors in California
Felons, including sex offenders, are allowed to work as substance abuse counselors in California because of lax rules, according to a new report. The state Senate Office of Oversight and Outcomes found California does not require criminal background checks for drug and alcohol counselors. Applicants are not required to report their criminal histories, the Los Angeles Times reports. At least 23 sex offenders have been allowed to work as substance abuse counselors since 2005, the report found. “Almost all other large states want to know about serious convictions before credentialing drug and alcohol counselors, even if the disclosure doesn’t automatically disqualify them,” the report notes. There are an estimated 36,000 registered or certified substance abuse counselors in California, and that number is expected to grow as more people gain health insurance under the Affordable Care Act. Although counselors must be registered with or certified by one of seven private organizations in the state, they can continue working even if they have their registration or certification revoked, by signing up with a different organization, the report found. The report recommends the state be put in charge of credentialing counselors. An alternative would be to require certifying organizations to perform background checks. David Peters, a spokesperson for the California Association of Addiction Recovery Resources, one of the certifying organizations, said his group supports background checks. He noted many people become counselors while in recovery from addiction, and cautioned against disqualifying someone simply because they have a criminal history that includes drug use.

Treating addiction as an ailment not a crime
So, how are the courts coping with heroin? While drugs account for relatively few criminal charges — the Greenfield Police Department logged 47 drug violations and 68 DUIs in 2010, in contrast to 215 break-ins or burglaries and 388 assaults, sex crimes and intimidations — local courts acknowledge addiction or substance abuse as an underlying factor in as many as 80 or 90 percent of their cases. Many addicts find themselves in court for behavior resulting from drug use, not the drug possession itself. So, locally, both the Greenfield and Orange district courts operate “drug court” programs, designed to get at some of the drug-related underlying problems. Despite the name, drug court is essentially an enhanced form of probation. The program — which emphasizes solving the underlying problems instead of doling out automatic punishment — were instituted as part of Franklin County’s Reinventing Justice initiative in the 1990s. Continue reading here.

Commentary: Drug Courts’ Positive Effects on Families and Society
Jails and prisons in America are overflowing with people who suffer from substance use disorders. In fact, more than three quarters of inmates have either been arrested for a drug- or alcohol-related crime, have been intoxicated at the time of their arrest, have a history of regular drug or alcohol use, or have previously received drug or alcohol treatment. Despite what most people think, the association between drugs and criminal behavior is not solely due to people committing crimes to further their drug habit. Drug use is actually a factor in many crimes that have nothing to do with obtaining money for drugs. In fact, drug use is implicated in 50 percent of violent crimes, 50 percent of instances of domestic violence and 80 percent of child abuse and neglect cases. Historically, policies addressing substance abuse and crime have shifted back and forth between either using treatment or using criminal sanctions. But research indicates that a more balanced approach that incorporates both treatment and criminal justice supervision is more effective. This is where drug courts come in. Drug courts are specialized courts that offer people arrested for drug-related crimes an opportunity to obtain community-based treatment coupled with close judicial supervision as a way of avoiding sentencing and potential incarceration. By successfully completing this voluntary program, individuals have the potential to avoid criminal penalties and even have the arrest erased from their permanent record. Drug courts represent a criminal justice approach that takes into account the need to ensure public safety through close supervision, and public health through the delivery of community-based treatment. They are among the most effective ways to address the problem of substance abuse and crime. Drug courts improve people’s lives in a variety of ways. They have been shown to increase rates of employment, help people obtain stable living arrangements, improve mental and physical health, and enhance interpersonal relationships. The improvements to the individual, their community and society are almost too numerous to mention. Perhaps one of the most important and far-reaching effects of a drug court, which is often overlooked, is the positive impact it has on families who have been negatively affected by their loved one’s addiction. These families often face poverty, strained or broken relationships and separation from spouses or parents. The positive healing and restorative effects of drug courts on the family are dramatic. One need only talk to a drug court alumnus, go to a drug court graduation or attend an annual National Association of Drug Court Professionals conference to witness these effects. As a result of drug courts, mothers and fathers can regain custody of their children, provide for their families and become productive members of their community. The personal evolution that many drug court participants undergo is nothing short of astounding. As we approach the end of National Drug Court Month, we should continue to recognize the important role that drug courts serve in helping individuals and families overcome the devastating effects of addiction.
Source: David S. Festinger, PhD, is Director of Treatment Research Institute’s Section on Law & Ethics and Karen Leggett Dugosh, PhD, is a Research Scientist for Treatment Research Institute’s Section on Law & Ethics.

Addiction to Drugs, Alcohol, Tobacco Most Common Mental Health Problem in Teens
Addiction to drugs, alcohol and tobacco are the most common mental health problems in teenagers, a new government report concludes. Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed problem overall in youth ages 3 to 17, NBC News reports. The findings, from a report by the Centers for Disease Control and Prevention (CDC), found almost 7 percent of children under 18 are diagnosed with ADHD, while 3.5 percent have behavioral problems and 1.1 percent have autism. An estimated one million teenagers abuse drugs or alcohol, and more than 695,000 are addicted to tobacco, the CDC found. The agency found during 2010-2011, a total of 4.2 percent of teens were dependent on or abused alcohol in the past year. An estimated 4.7 percent of teens had an illicit drug use disorder in the past year. Use of illicit drugs during the past month varied by age. Among teens ages 12 to 13, 1.3 percent used marijuana, compared with 6.7 percent of 14- to 15-year-olds and 15.1 percent of 16- to 17-year-olds.

Georgia “Generation Rx” Campaign Aimed at Curbing Teen Prescription Drug Abuse
Georgia launched a campaign this week, “Generation Rx,” aimed at preventing prescription drug abuse in teens and young adults. The campaign is funded through a grant from the Substance Abuse and Mental Health Services Administration, according to the Associated Press. It is focused on 12- to 25-year-olds. The campaign includes education and awareness about the dangers of prescription drug abuse, and promotes Georgia’s Prescription Drug Monitoring Program. It also features education about how to properly dispose of unused and expired medications, and collaboration with law enforcement to eliminate improper prescribing practices. In a statement, Georgia Department of Behavioral Health and Developmental Disabilities Commissioner Frank Berry said, “The abuse of prescription drugs by youth in Georgia and across the country has grown substantially since the 1990s. Every day, 2,500 youth aged 12 to 17 abuse a prescription pain reliever for the first time, and nearly 20 percent of teens report abusing medications that were not prescribed to them.”

Hard Cases: The Traps of Treating Pain
I hadn’t seen Larry in a dozen years when he reappeared in my office a few months ago, grinning. We were both grinning. I always liked Larry, even though he was a bit of a hustler, a little erratic in his appointments, a persistent dabbler in a variety of illegal substances. But he was always careful to avoid the hard stuff; he said he had a bad problem as a teenager and was going to stay out of trouble. It was to stay out of trouble that he left town all those years ago, and now he was back, grayer and thinner but still smiling. Then he pulled out a list of the medications he needed, and we both stopped smiling. According to Larry’s list, he was now taking giant quantities of one of the most addictive painkillers around, an immensely popular black-market drug most doctors automatically avoid prescribing except under the most exceptional circumstances. Continue reading here.