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Thursday, January 24, 2013

ATOD & Advocay Weekly News Recap - Week-ending January 24th



Making Sense of the Stats on Binge Drinking. What you need to know about the CDC’s report on binge drinking in women and girls
  
The trouble with statistics is that each morsel of information raises an infinite number of questions. To make any sense of it, you often need a good bit of related data to avoid a partial picture that distorts the view. So, when it comes to the U.S. Center for Disease Control and Prevention's recent report on binge drinking in America, U.S. News aims to provide you with a fuller picture of the problem. For starters, binge drinking is defined, for females, as four or more drinks on one occasion, and, for males, five or more­­. These quantities are generally considered to raise the blood-alcohol level to (or even well over) .08, the legal limit for driving. While binge drinking has long been associated with men and boys, it is, in fact, a common occurrence among females; one in eight women and one in five high school girls engage in the behavior, leading to some 23,000 deaths among American women and girls each year. "There's been a shift in the drinking culture," where "males and females are considered equal, and unfortunately that has led to a stubborn level of binge drinking among girls," says Aaron White, health scientist administrator at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), a division of the National Institutes of Health. To put it more bluntly, "they started to drink more like boys and they're not letting go," he says. Click on link to read the rest of the story: http://health.usnews.com/health-news/articles/2013/01/17/making-sense-of-the-stats-on-binge-drinking.


‘Drinking Mirror’ app shows effects that alcohol can have on facial appearance

New app shows how drinking might make a person look prematurely old.

Ever wonder about the impact all that drinking has on your looks? “Drinking Mirror,” a new smartphone app, aims to show you. The free app, part of the “Drink Smarter” campaign by the Scottish government to make people aware of the line between social drinking and binge drinking, plays on people’s vanity and specifically targets women. Android and iPhone users with the “Drinking Mirror” app are able to upload or snap photos of themselves and enter information about their drinking habits. Once they do so, they will see how their faces might age if they continue to drink at their current rate. The app’s Web site, which seeks to spread awareness about health concerns associated with excessive alcohol consumption, warns that weight gain, dull skin, wrinkles and red cheeks are associated with drinking heavily on a regular basis. Read more at http://www.drinksmarter.org/handy-tools/drinking-mirror-app


Commentary: Time to “Make An Impact” on Rx Epidemic
Every month approximately 1,200 calls are received from individuals in southern and eastern Kentucky seeking help with an addiction issue. Multiply this by the hundreds of regions across America and it’s easy to understand why the Centers for Disease Control and Prevention consider prescription drug abuse a public health “epidemic.” One accidental overdose death every 19 minutes; more than the number of deaths from car crashes. That’s a sobering statistic. Families and communities are being torn apart, and our children are not immune to addiction’s deadly consequences. Rest of the commentary is available here.


Military Deployment Increases Risk of Substance Abuse in Young Family Members

Having a parent or sibling who has been deployed in the military increases the risk of drug and alcohol use among middle and high school students, a new study finds. The study found multiple deployments by a parent or sibling was linked with an increased risk of lifetime and recent use of drugs and alcohol, MedicalXpress reports. The study found a high number of deployments was linked with a 14 percent increase in the likelihood of lifetime drug use, and an 18 percent increased risk of recent use. The researchers at the University of Southern California School of Social Work found youth in grades 5 to 11 with a sibling in the military were more likely to use drugs than those with a parent in the military. The findings appear in the American Journal of Preventive Medicine. “The potential for strain and the trauma associated with multiple deployments in the past 10 years of war seem to be driving this. People need to be aware that these experiences have an impact,” lead author Tamika Gilreath said in a news release. She added, “Everyone talks about the impact of parents, but no one talks about the impact of other close family members, such as siblings. There is research to suggest that the deployment of a sibling is similarly disruptive as parental deployment. Parental concern may influence their interactions with the younger sibling who is left to cope with their own sense of loss as well as their parents’.” The researchers suggest schools with a high density of students with deployed family members should consider providing education about substance use. They also recommend that community medical providers increase substance abuse screening in these children.


Smoke-Free Laws Lead to Fewer Children Hospitalized for Asthma Attacks: Study

British researchers say there appears to be a link between smoke-free laws and a drop in the number of children hospitalized for asthma attacks. Their study found a 12.3 percent decrease in hospital admissions for childhood asthma attacks in the first year after smoke-free laws were enacted in Britain. The law prohibits smoking in enclosed public places and workplaces, according to Reuters. Before the law went into effect, hospital admissions for children with severe asthma attacks were rising by 2.2 percent annually. Admission rates began to drop immediately after the law went into effect, the article notes. The trend was seen in boys and girls of all ages, in both wealthy and poor neighborhoods, and in urban and rural areas. This change was equivalent to 6,802 fewer hospital admissions in the first three years after implementation of the smoke-free law, the researchers wrote in the journal Pediatrics. Lead researcher Dr. Christopher Millett of Imperial College London School of Public Health noted in a news release, “There is already evidence that eliminating smoking from public places has resulted in substantial population health benefits in England, and this study shows that those benefits extend to reducing hospital admissions for childhood asthma. Previous studies have also suggested that the smoke-free law changed people’s attitudes about exposing others to second-hand smoke and led more people to abstain from smoking voluntarily at home and in cars. We think that exposing children to less second-hand smoke in these settings probably played in important role in reducing asthma attacks.”


Seeking “Higher” Ground: The Dangers of Designer Drugs
Since ancient times, humans have been fascinated with ways to alter consciousness, and have gone to great lengths to reach a “higher” ground.  From naturally occurring substances such as opium and betel nuts, to synthetic drugs like LSD, people have long experimented with mind-altering substances. This long history of experimentation with psychoactive substances even pre-dates the existence of the word “drug.” Read the rest of the article here


Deadly Pills: A National Epidemic

Drugs are now the No. 1 accidental killer in the U.S., with the vast majority of deaths caused by prescription meds. This week, PEOPLE offers a look at how medicines that are now a part of everyday life can also turn families upside down forever. The statistics are staggering, the medicines powerful and highly addictive: This year more Americans will die of drug over-doses than in any other type of accident – including car crashes. In most cases, those deaths are caused by pills in many people's medicine cabinets given to them by trusted doctors, left over from routine surgeries or prescribed to manage chronic conditions. Rest of the story is available here.



NGA Promotes Prescription Drug Abuse Project
On Wednesday, January 9th, the National Governor’s Association (NGA) convened a press conference on the State of the States at the National Press Club. The Chairman of the NGA, Jack Markell (D-DE) and the Vice Chair, Mary Fallin (R-OK), highlighted key policy topics that the Association and its members plan to address in 2013. The Governors included the Prescription Drug Initiative that was launched in 2012, led by Governors Robert Bentley (R-AL) and John Hickenlooper (D-CO). The initiative includes the Prescription Drug Abuse Reduction Policy Academy, which consists of 7 States developing and implementing comprehensive and coordinated strategies. Those States include Alabama and Colorado, as well as Arkansas, Kentucky, New Mexico, Oregon, and Virginia. In September, the Initiative released an issue brief describing six strategies for reducing prescription drug abuse. For more information visit, National Governor’s Association Prescription Drug Abuse Project For the full Issue Brief visit, Six Strategies for Reducing Prescription Drug Abuse


DEA Releases Proposed Rule on Disposal of Controlled Substance Prescription Drugs (Taken from DEA Press Release)
On Friday, December 21st, the Drug Enforcement Administration (DEA) released a proposed rule to implement the Secure and Responsible Drug Disposal Act of 2010. The rule proposes requirements to govern the secure disposal of controlled substance medications by both DEA registrants and what the Controlled Substances Act refers to as “ultimate users” of these medications (patients and animals).  The proposed rule seeks to expand the options available to collect these medications from ultimate users for the purpose of disposal, to include take-back events, mail-back programs, and collection box locations.  The proposed rule contains specific provisions that:
  •         Continue to allow law enforcement agencies to voluntarily conduct take-back events, administer mail-back programs, and maintain collection boxes;
  •          Allow authorized manufacturers, distributors, reverse distributors, and retail pharmacies to voluntarily administer mail-back programs and maintain collection boxes;
  •          Allow authorized retail pharmacies to voluntarily maintain collection boxes at long term care facilities.

Click here for the proposed rule. The public has 60 days to submit comments (February 19th, 2013). Should you have any questions or concerns, do not hesitate to contact Michelle Dirst, Director of Public Policy, at mdirst@nasadad.org or Andrew Whitacre, Public Policy Associate, at awhitacre@nasadad.org



Alcohol Use from Adolescence to Adulthood Follows Different, Complex Pathways

Adolescence is often a time of novelty seeking and risk taking, including the initiation of drinking. While heavy drinking that begins in adolescence can lead to problematic alcohol use later in life, other risk factors are also involved in trajectories of alcohol use that may develop. A study of factors predicting alcohol use and patterns of use over time has identified six distinct trajectories that concern level of alcohol use, rate of increase in use during early adolescence, and persistence of use into adulthood. Results will be published in the March 2013 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"Increased levels of exploration and risk taking seem to mark the transition from adolescence to adulthood," said Marieke Wichers, associate professor at Maastricht University Medical Centre as well as corresponding author for the study. "From an evolutionary point of view, this boost of explorative behaviour may be advantageous to adolescents in order to get to know the world around them and become independent. Thus, we see that that all over the world – on average – adolescents have higher levels of novelty seeking and are more risk taking that other age groups." "Some teens begin adult behaviors ranging from sexual behavior to driving to taking their first job very early while others delay initiating these behaviors," added Victor Hesselbrock, professor of psychiatry at the University of Connecticut School of Medicine. "Novelty seeking is likely one of several personality factors that may influence the timing of the initiation of drinking behaviors. Many do consider teenage drinking a 'rite of passage,' given the ubiquity of the behavior across different environments and cultures." "We tried to identify whether subgroups exist that follow similar changes in alcohol use over time," said Wichers. "This is important in order to differentiate adolescents in terms of their future course of alcohol use and identify the characteristics that may predict which course adolescents will follow."

"Most current studies of alcohol and other substance use in adolescence now use some variant of the 'developmental trajectories' approach," noted Hesselbrock. "This study is somewhat unique in that the sample size is fairly large and contains both girls and boys. Importantly, it assesses a number of relevant psychological traits and environmental factors considered either risk or protective for onset of drinking behavior. The sample also covers the age range of 15 to 36 years of age. This is important as it captures the typical age of initiation of drinking but also other drinking milestones such as first intoxication, onset of regular drinking, appearance of early drinking problems, as well as the period of time in early adulthood when drinking behaviors further diverge into different patterns."

Wichers and her colleagues obtained retrospective data from 1,560 adult male twins concerning their average monthly alcohol use, as well as risk and protective factors in their lives, through interviews and questionnaires. The age span addressed was from 15 to 36 years of age. Risk factors included parental alcohol use, poor school performance, and specific personality traits. Protective factors included religiosity, parental monitoring, and social activities. "We found six different subgroups of individuals that could be clustered together in terms of their trajectories of alcohol use," said Wichers. "Alcohol use in these six trajectories differed in terms of, one, overall level of use, in that some subgroups used more alcohol than others, two, peak of alcohol use, in that some subgroups had a more pronounced early peak of use in early adolescence than other subgroups, and three, persistence of use, in that two subgroups were both characterized by a sharp increase in use during adolescence and high levels of use."

"Again, the sample of 15-36 years of age is important as it captures the typical age of initiation of drinking to the time of maximum consumption, typically ages 18-22," said Hesselbrock. "However, it also captures other drinking milestones into adulthood when drinking patterns further diverge, typically showing either significant decreases in alcohol consumption or a trajectory towards chronic alcoholism." "After identifying these different subgroups, a second aim of this study was to find personal characteristics that might predict to what subgroup individuals may belong," said Wichers. "We found that a number of risks that predicted average alcohol consumption did not always predict the pattern of alcohol use over time. For instance, sensation seeking and low school performance were associated with a higher average level, but not with an early peak pattern, of alcohol use. On the other hand, peer deviance, ADHD symptoms, and genetic risk of externalizing disorders impacted on the timing of alcohol use in early adolescence. Among the most striking findings was that genetic risk for externalizing problem behavior and peer deviance was the strongest predictor of belonging to subclasses with initial high average consumption and an early peak in alcohol consumption during adolescence. In summary, this study showed that these predictors do not all influence alcohol use in the same manner: some predict increased level of use while others predict pattern of use in early adolescence or persistence of high-level alcohol use. Thus, indeed there seems to be a varied influence of certain factors at different stages in one's life."

Hesselbrock agreed. "This study clearly shows that 'one size' or one risk factor does not fit all," he said. "The importance of different vulnerability varies from latent class to latent class, with different risk factors affecting consumption levels and consumption patterns over time. Similarly, so does the importance of different well-known protective factors such as church attendance, parental attitudes, and parental monitoring." Both Wichers and Hesselbrock said that future research is a necessity.

"Before a clinician can use these findings to construct an effective intervention, other research needs to examine whether these identified predictors are causal," said Wichers. "Then clinicians may use this knowledge to construct intervention strategies and identify individuals at risk." "We need to determine whether behavioral, pharmacological, or both types of treatments targeted for specific classes will be more effective," said Hesselbrock. "We need to identify more specific genetic determinants that can be addressed either pharmacologically or by a behavioral intervention. It will also be interesting to see how these findings relate to quantity and patterns of use of other substances such as tobacco and marijuana, given that teens typically use a variety of substances, not just alcohol alone. Treatment providers should keep these different trajectories in mind and adjust their treatment plans as necessary as they follow their patients forward. Remember that this study is observational; the question remains whether these different class memberships and drinking trajectories can be changed with treatment."


Alcohol Can Cause Sleep Disruption in Second Half of the Night, Study Finds

Drinking alcohol may help a person fall asleep, and increase deep sleep during the first half of the night, but can disrupt sleep during the second half, a new study finds. Researchers reviewed 20 previously published studies on alcohol and sleep, according to NBCNews.com. They found alcohol reduced the time it takes people to fall asleep, and helped them to sleep more deeply during the first half of the night, no matter how much they consumed. During the second half of the night, sleep disruption, or waking after falling asleep, increased. Having at least two drinks reduced overall rapid eye movement (REM) sleep. Dreaming occurs during REM sleep, and is thought to be important for memory, the article notes. The study included people who were healthy, and who were tested in an overnight sleep lab. It will be published in the journal Alcoholism: Clinical and Experimental Research. “Alcohol on the whole is not useful for improving a whole night’s sleep,” study co-author Chris Idzikowski, Director of the Edinburgh Sleep Centre, said in a news release. “Sleep may be deeper to start with, but then becomes disrupted. Additionally, that deeper sleep will probably promote snoring and poorer breathing. So, one shouldn’t expect better sleep with alcohol.”


U.S. Appeals Court Refuses to Overrule DEA on Marijuana

A U.S. Appeals Court this week refused to overrule the Drug Enforcement Administration’s (DEA) classification of marijuana as a dangerous drug with no accepted medical uses, the Los Angeles Times reports. The marijuana advocacy group Americans for Safe Access had sued the government, arguing the DEA had a duty to reexamine the medical evidence, and to reclassify marijuana as a drug with benefits for those suffering and in pain, the article notes. Rest of the story is here.


Proposal to Increase Restrictions on Opioid Prescribing Prompts Debate

A proposal by the Drug Enforcement Administration (DEA) to more tightly control prescriptions of drugs containing hydrocodone is prompting debate among doctors, according to NPR. A committee of the FDA will meet January 24 and 25 to consider the DEA’s request. Emergency room visits related to hydrocodone, the key ingredient in Vicodin and other painkillers, have soared since 2000. Vicodin, which also contains acetaminophen, is subject to fewer regulations than pure hydrocodone. Click here to read the rest.


Teaching Teens to Manage Personality Traits May Reduce Problem Drinking

High school programs that teach teens to better manage their personality traits can help reduce and postpone problem drinking, a new study suggests. “Two factors determine problem drinking: personality and peer pressure,” said study author Dr. Patricia Conrod of King’s College London’s Institute of Psychiatry. “Teaching young people how to better manage their personality traits or vulnerabilities helps them make the right decisions in given situations, whether it is a matter of overcoming their fears, managing thoughts that make them very emotional, controlling their compulsions, analyzing objectively the intentions of others or improving their self-perception.” In the two-year study, high school staff in London worked with ninth-grade students, who were divided into two groups. One group participated in a personality-based intervention program run by school staff, while the second group received the standard United Kingdom drug and alcohol curriculum. All of the students’ drinking patterns were examined. Students filled out a personality questionnaire to determine their risk of developing future alcohol dependence. Personality traits identified with a greater risk of alcohol dependence included impulsivity, hopelessness, sensation-seeking, or anxiety, Newswise reports. School staff members trained in the personality-based program delivered group workshops targeting the different personality profiles. The workshops taught the teens to better manage their personality traits. “Our study shows that this mental health approach to alcohol prevention is much more successful in reducing drinking behavior than giving teenagers general information on the dangers of alcohol,” Dr. Conrod said in a news release. After two years, the study found high-risk students in the intervention group had a 29 percent reduced risk of drinking, a 43 percent reduced risk of binge drinking, and a 29 percent reduced risk of problem drinking, compared with high-risk students in the standard drug and alcohol education programs. The intervention also significantly slowed the progression to more risky drinking behavior in the high-risk students over the two years. The study appears in JAMA Psychiatry.


Recovery Using the 12 Steps

Most therapists do not realize that the 12 Steps are not merely an antidote for addiction, but are guidelines for nothing less than a total personality transformation. Bill Wilson, the founder of Alcoholics Anonymous, was influenced by Carl Jung. In correspondence, Jung wrote Wilson that the cure for alcoholism would have to be a spiritual one — a power equal to the power of spiritus, or alcohol.  The 12 Steps are that spiritual remedy. They outline a spiritual process of surrender of the ego to the unconscious, or a higher power, and very much resemble the process of transformation in Jungian therapy. Click here to read the rest of the story.

Friday, January 18, 2013

ATOD Weekly Recap - Week-ending January 18th

Do College Students View Alcohol or Drug Use as a Problem?
Alcohol and drugs are present on college campuses virtually everywhere. So are symptoms of psychological issues, such as anxiety, depression, and post-traumatic stress. However, a small percentage of students who need help for these issues ever actually seek out mental health services. Is it that they don’t see drug and alcohol use as a problem? The answer to that question varies. According to a recent study led by Robert J. Lowinger of Bluefield State College in West Virginia, college men and college women perceive the effects and severity of drug and alcohol use differently. In his study, Lowinger interviewed 201 college students using a modified version of the Degree of Impairment Scale (DIS) to assess how drug use and alcohol consumption interfered with their lives with respect to academic performance, career, daily routine, social engagement, romantic relationships, and friendships. He looked at how the students rated severity of use and which types of impairments increased help seeking, and which students were most likely to seek help. He found that all of the participants viewed drug problems as more problematic than alcohol problems. Females were more likely than males to seek help for problems with drugs or alcohol and cited more academic and daily routine impairments as a result of drug or alcohol use. Even though the students listed minimal impairments with peer interactions and other social relationships, drug use related to this did not motivate them to seek help, but alcohol use that impaired social interaction did. This could be due to the fact that alcohol is more socially acceptable and present than drug use, and therefore more students have alcohol related problems than drug related problems. The results of this study were based solely on self-reports, which could distort the data. Additionally, the small sample size prohibited Lowinger from revealing any cultural, sexual orientation, or racial patterns. “Nevertheless, this study suggests that there are significant differences in the way that students’ perceive problems relating to drugs and alcohol use,” said Lowinger.= Reference: Lowinger, Robert J. College students’ perceptions of severity and willingness to seek psychological help for drug and alcohol problems. College Student Journal 46.4 (2012): 829-33.
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Using Bath Salts: Playing Russian Roulette With Your Brain, Expert Say
Using the designer drugs known as “bath salts” is like playing Russian roulette with your brain, according to an expert at the National Institute on Drug Abuse (NIDA). Michael H. Baumann, PhD, Chief of the Designer Drug Research Unit at NIDA’s Intramural Research Program, recently published a study that explains how bath salts cause dangerous effects in the brain. Read the rest of the story here.
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More Homeless Die From Drug Overdoses Than From AIDS
A greater percentage of homeless adults die from drug overdoses than from AIDS, according to a new study. Drug overdoses accounted for nearly 17 percent of all deaths among homeless patients studied, and 81 percent of the overdoses involved opioid painkillers and heroin. In contrast, 6 percent died of causes related to AIDS. Health issues related to substance abuse, such as alcoholism-associated heart disease, pneumonia and withdrawal, accounted for 8 percent of deaths. The results appear in JAMA Internal Medicine. Researchers studied 28,033 homeless adults in Boston over five years. The study authors and homeless advocates say their findings apply to homeless populations in many urban areas of the country, Reuters reports. In a similar study conducted 15 years earlier, 6 percent of deaths among homeless adults were due to drug overdoses, while 18 percent were due to AIDS. “Our findings are an unfortunate reminder of the high mortality rate of homeless people and a clarion call for the need to address the epidemic of drug overdose deaths in this vulnerable population,” lead researcher Travis Baggett, MD, MPH, of the Massachusetts General Hospital, said in a news release. Jessie Gaeta, Medical Director of the Boston Health Care for the Homeless Program, told Reuters her group is considering making changes as a result of the findings, including decreasing the amount of painkillers it prescribes, and providing patients with naloxone, which can be used as an overdose antidote. The program’s doctors prescribe painkillers to some homeless patients with chronic pain, she said. They are increasing efforts to counsel patients on how to properly use their medication, and how to protect against medication theft.
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New Study Questions Finding of Earlier Research on Marijuana and IQ in Teens
A new study calls into question the results of a study published last year that concluded heavy marijuana use can permanently lower IQ by several points in teens. The new research suggests that the IQ drop may have been caused by factors related to economic class and home life, NBC News reports. The new study used a computer simulation to demonstrate that the same effects on IQ could have been caused by socioeconomic factors, according to researcher Ole Rogeberg of the Frisch Center in Norway. “The kinds of environments you are in do affect your IQ,” Rogeberg told NBC News. He noted that while a good education and challenging employment can increase intelligence, “if people are pushed out or decide to move out of these kinds of arenas, they will tend to see an IQ decline, and they will also be the type of people who tend to take up cannabis smoking during adolescence.” The findings are published in the Proceedings of the National Academy of Sciences. The original study included data from 1,037 New Zealanders who were followed for more than three decades, starting at age 7. The researchers found marijuana lowered IQ by as much as eight points for those who started using the drug in adolescence, and were heavy, lifelong users. The study found no effect on IQ in people who started using the drug as adults, which suggested marijuana was particularly harmful for developing brains. Rogeberg noted his new findings do not mean marijuana is harmless. He recommended the original researchers should more thoroughly analyze their data to prove marijuana, and not other factors related to the marijuana-smoking lifestyle, can lower IQ.
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10 over-the-counter medicines abused by teens
Is your medicine cabinet a source for a teen’s legal “high?” Because a doctor’s prescription is not needed, many mistakenly believe that over-the-counter (OTC) medicines are safer than prescription medicines and illegal street drugs. They are in fact safe and effective when taken as directed, but even OTC medicines—including herbals—can cause serious and potentially fatal side effects when abused.  Read the rest of the story here.
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Dieting and drinking a bad mix - Those calories can add up
The first rule of drinking on a diet is: Don’t. Surely you’ve heard that Americans get way too many calories — and nutritionally empty calories at that — from alcohol. But the second rule of drinking on a diet is that since you probably will ignore Rule No. 1, find a way to enjoy alcohol without letting it swamp your healthy intentions. Here are a few suggestions on how to go about that. Read the rest of the story here.
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NASADAD Releases Statement on the Use of Medication for Substance Use Disorders

Association notes that medications represent an important tool to consider in the treatment of substance use disorders

The National Association of State Alcohol and Drug Abuse Directors’ (NASADAD) Board of Directors approved during its December Meeting a consensus statement regarding the benefits of using medications in the treatment of substance use disorders.  The statement points to research from the National Institutes of Health (NIH) demonstrating the effectiveness of FDA-approved medications when prescribed as part of a comprehensive and individualized treatment plan.  NASADAD concludes that public and private health insurance plans should cover medications for the treatment of opioid, alcohol, and nicotine dependence.   “We believe it is important to promote evidence based, clinically appropriate care,” said Mark Stringer, President of NASADAD.  “As a result, NASADAD moved forward to educate stakeholders on the fact that all FDA-approved medications should be made available to help certain people enter into and maintain recovery from substance use disorders,” said Stringer.  According to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 20.6 million persons met criteria for substance dependence or abuse in 2011.  Prescription drug abuse and misuse represents a particular challenge in State substance abuse systems across the country:  from 1998 to 2008, there was a 400 percent increase in admissions to treatment for people 12 and older misusing prescription pain relievers (SAMHSA, 2010).  In addition, approximately 16.7 million Americans in 2011 were dependent on alcohol or had problems related to their use or abuse of alcohol (SAMHSA, 2012).  The good news is that advances in research and practice have shown people suffering from alcohol and opiate dependence – including heroin addiction – may benefit from a medication as an adjunct to treatment.  As noted in the NASADAD statement, “A growing body of research substantiates that the use of FDA-approved medications can play an important role for people with alcohol, opioid, or nicotine dependence, with continued research being done on medications for other substance use disorders.”  NASADAD also cites that for certain people, “…use of medication is recommended as a recovery tool.”  “Decisions are being made about the nature and scope of services that should be made available to people with substance use disorders,” said Robert Morrison, NASADAD’s Executive Director.  “We hope our work will help contribute to this dialogue and encourage informed choices.”  While the statement was approved by the Board of Directors, the document was developed by NASADAD’s National Treatment Network (NTN), in conjunction with its Opioid Treatment Network (OTN).  A workgroup met via conference calls, in-person meetings and electronically to write an initial draft.  In addition to the statement, the NTN and OTN have engaged in State-to-State learning opportunities regarding medication assisted treatment through meetings, topic calls and more.
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New York Police Department to Use Decoy Pill Bottles to Track Painkiller Thieves
The New York Police Department has announced it will put decoy pill bottles with tracking devices on pharmacy shelves, in an effort to track stolen painkillers. The fake bottles will appear to contain oxycodone, The New York Times reports. The bottles will not actually contain painkillers, but will have a GPS device. “We would anticipate the burglar and robber will take numerous bottles, and among them will be the bait bottle,” said the department’s chief spokesman, Paul J. Browne. The fake bottles rattle when they are shaken, as if they contained pills. They sit on a special base. When the bottle is lifted from the base, it starts to send out a tracking signal. The department hopes to have the program in place by March, and is asking all of the city’s 1,800 pharmacies to participate. Purdue Pharma, which makes OxyContin, developed the bottles. They are already being used in some pharmacies around the country. Around the nation, pharmacies have been robbed by armed criminals looking for narcotics, anti-anxiety drugs and other controlled medications. Some are addicted to the drugs themselves, while others sell the pills.
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Many Doctors Skip Alcohol Screening and Miss Patients’ Drinking Problems
Doctors miss drinking problems in almost three-fourths of patients because they don’t conduct alcohol screening, a new study finds. Instead, many doctors rely on gut feelings about whether a patient is engaging in problem drinking. By asking a few questions about drinking habits, doctors can spot alcohol problems, and help patients cut back on drinking, experts told CNN. Researchers asked almost 1,700 adults to complete questionnaires at the end of a primary care doctor’s visit. Several questions addressed drinking habits, such as how often they drank, how many drinks they usually had per day, and if their drinking ever put them at risk of being hurt or causing an accident. After the visit, doctors were asked whether they thought the patient had problems with alcohol. Doctors who relied on a hunch about whether the patient had a drinking problem, instead of conducting a screening, missed almost three-fourths of patients who screened positive for alcohol problems. Doctors who did suspect a drinking problem were usually correct, the study found. “I hope that by papers like this, it’s going to be a nudge to a physician to say … ‘Maybe I should start screening.’ It’s not that hard to do,” said study author Dr. Daniel Vinson of the University of Missouri School of Medicine. The study appears in the Annals of Family Medicine. Alcohol screening is recommended by the U.S. Preventive Services Task Force, but is often not part of routine care, according to the CNN report. Previous research has shown that screening and brief interventions by health care providers — asking patients about alcohol use and recommending they reduce risky drinking — can promote significant, lasting reductions in drinking levels and alcohol-related problems, according to the National Institute on Alcohol Abuse and Alcoholism.
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States Should Use More Tobacco-Related Income for Prevention: Report
States use little of the income they receive from tobacco taxes or legal settlements with cigarette manufacturers to pay for smoking prevention or cessation programs, the American Lung Association concludes in a new report. Although states receive a total of $25.7 billion in tobacco settlement payments and tobacco taxes annually, more than 40 states do not invest even half of what is recommended by the Centers for Disease Control and Prevention (CDC) in proven tobacco prevention programs, according to the report. Some states receive money from tobacco companies under a 1998 anti-smoking agreement with tobacco companies, Reuters reports. States spent a total of $462.5 million on smoking prevention and cessation programs this fiscal year, about 12.5 percent of the CDC recommendation. North Dakota and Alaska were the only states that spent amounts close to the recommendation. Some states put most of their tobacco-related income toward their general budgets. The report notes that states and the federal government have not raised taxes on tobacco products other than cigarettes, which has led to a surge in the use of certain cheaper tobacco products, including flavored cigars popular among youth. “By not having a level playing field with tobacco taxes, we’re seeing market shifts from cigarettes to lesser taxed and subsequently more affordable tobacco products. This means candy flavored cigars and a new wave of smokeless products are enticing new, young customers to become addicted to nicotine,” Paul G. Billings, American Lung Association Senior Vice President for Advocacy and Education, said in a news release.
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Mothers, Daughters and Alcohol
There seemed to be both collective surprise and some very intense buzz after a very recent report found that many more women have been drinking than was previously thought. According to this CDC report, approximately 13% of women in the U.S. over the age of 18 engage in binge drinking.  In this survey, a binge was defined as consuming four or more alcoholic beverages during one discrete episode or evening or event. The nation was even more surprised to learn that among the 7,536 females in grade 9-12 who were surveyed, there was also plenty of binge drinking. The likelihood of binge drinking increased by grade. In 9th grade, 13% of the girls reported binge drinking. By the time they were in 12th grade, up to 27% of the girls reported binge drinking. Read the rest of the blog here.
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ER visits tied to energy drinks double since 2007
SAN FRANCISCO (AP) — The young man stumbled into the emergency room late one night after a house party, saying his heart wouldn't stop pounding and he could barely breathe after downing liquor mixed with energy drinks. Emergency physician Steve Sun soon found the patient was so dehydrated he was going into kidney failure — one of many troubling cases Sun says he has treated in recent years tied to energy drink consumption. Sun's changing caseload appears in line with a new government survey that suggests the number of people seeking emergency treatment after consuming energy drinks has doubled nationwide during the past four years, the same period in which the supercharged drink industry has surged in popularity in convenience stores, bars and on college campuses. Remainder of article is available here.
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Prescription Drug Overdoses Number One Reason for ER Visits in Los Angeles County
Prescription drug overdoses are the number one reason for emergency room visits in Los Angeles County, according to public health officials. A new report finds the number of people who checked into publicly funded drug rehabilitation programs for prescription pain reliever abuse doubled from 2005 to 2010, NBC Los Angeles reports. More than 60 percent of drug-related deaths in 2011 were due to prescription drugs in Los Angeles County. The report found 11 percent of 9th graders and 14 percent of 11th graders said they had misused prescription drugs at least once. “Prescription drug abuse has become a growing public health concern in Los Angeles County. Many people are not aware that the misuse or abuse of prescription drugs can be as dangerous as illegal drugs, and can lead to unintended injury, addiction, and even death,” Jonathan E. Fielding, MD, MPH, Director of Public Health and Health Officer, said in a news release. “We need to ensure that we are addressing this growing concern by engaging and collaborating with our partners in the public and private sectors to reduce and prevent prescription drug abuse.”
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Legalizing Pot Won't Make It Any Safer
Forgotten in the debate is the damage marijuana does to adolescent brains.
Pot is not legal—at least not yet. But it's not exactly illegal either—not anymore. More than a dozen states have decriminalized the possession of marijuana. Nearly a score of them sanction its medical use. Voters in Washington and Colorado have made recreational use of the drug legal in their states.  One way or another, all of these changes mean that there will be more marijuana in homes for young people to find and use. Granny may be smoking it for glaucoma, but there is nothing benign about the effects of pot on a juvenile brain. Whatever its legal status, pot is not harmless.  Marijuana hasn't achieved its present status of relative social acceptability by virtue of its virtues, but rather despite mounting evidence of the dangers it poses, especially to young users—and even more to users under age 18. While adults may be at risk, too, a considerable number of them appear to use marijuana in relative safety. So the case for prohibition has rested most securely on potential harm to adolescents.

Pot's potential for harm has as much to do with the nature of adolescence as it does with the nature of THC, the active ingredient in marijuana. That's because kids do foolish things because they are kids—and their brains are not yet fully developed. Unfortunately, the part of the brain that censors dumb and dangerous behavior is last to develop. It doesn't generally come fully on line until the mid-20s, but the pleasure-seeking part of the brain is fully functioning by puberty. So, kids do foolish things that are often risky—and get so much riskier when teenagers are high. Moreover, smoking marijuana is by itself a risky enterprise, and most addictive for the young. A study published in the Journal of Clinical and Experimental Pharmacology in 1994 found that one in 10 young people who use marijuana will go on to become addicted. Pot smoking puts the user at risk of psychosis, changes in the anatomy of the brain, and damage to the heart and lungs. It retards maturation and impairs learning, memory and judgment—no small matters during the adolescent years.
Among the many thousands of adolescents we have treated at the programs of Phoenix House over the past four decades, the overwhelming majority have used no drug more potent than marijuana. And for many of those young people, the course of their lives has been altered, sometimes permanently and often tragically, with suicides, car accidents and drownings—or with interrupted education, chronic depression and joblessness. Federal law still outlaws marijuana. Yet President Obama told Barbara Walters in December that "it does not make sense from a prioritization point of view for us to focus on recreational drug users in a state that has already said that under state law that's legal." Meanwhile, the Senate Judiciary Committee plans hearings to find some legislative route around the federal-state impasse. Given all that we know, the sensible strategy at this point is to send an unequivocal message that "legal" is not a synonym for "safe." This is not a novel concept. We have plenty of examples. Alcohol is legal and, in many ways, it can be even more threatening to teens than marijuana. Hand guns (and assault rifles) are also legal, but they are hardly benign.
While rational societies generally make some effort to protect children from obvious dangers, it is fundamentally a parental responsibility—and one that we humans share with the rest of the animal kingdom. It may be helpful if there is law on the parents' side. But this is not essential, nor does its absence diminish in any way a parent's familial obligations. There will be restriction on legal marijuana sales to children—following the alcohol template, states considering legalization use 21 as the legal age. But we cannot expect such restrictions to be any more effective in limiting teen marijuana use than they are in limiting teen smoking or drinking.  And then there is the issue of easier-than-ever access as more adults can buy or grow marijuana for their personal use. In 2000, a study commissioned by Phoenix House found that among 600 young people in treatment, only 1% were introduced to drugs by a dealer, and that a primary source of illicit drugs was relatives or family friends. At this point in the country's history, whether pot is legal or not is no longer the main issue. The issue is the danger that marijuana poses to kids, how parents can protect their children from that danger, and what the rest of society—absent the criminal justice system—can do to support them in that fight.

Dr. Rosenthal, a child psychiatrist, is the founder of Phoenix House, the nation's largest nonprofit substance-abuse treatment and prevention organization.
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New Jersey lawmakers hear testimony on a drug that mitigates overdoses' effects
Drug overdose is the leading cause of accidental death in New Jersey. It surpassed traffic fatalities in 2009, when 752 people died, according to a drug policy advocacy group. Of those deaths, 75 percent involved heroin or prescription opiates, a growing addiction problem in New Jersey and the nation. Legislators tried to address the issue last year when they approved the Good Samaritan Emergency Response Act, a bill that offered limited criminal amnesty to drug users who call for help when someone has overdosed. They took up the issue again Monday, when the state Senate's Health, Human Services, and Senior Citizens Committee heard testimony on a bill that would expand access to a drug that treats opiate overdose. Of the 43 people who showed up to support the bill, at least 14 had lost a family member to an opioid overdose.
Gov. Christie, a Republican and former prosecutor, surprised drug-addiction treatment providers last year with his stance on addiction. He put $2.5 million toward a court-run program that would force low-level offenders with drug problems into treatment rather than prison. New Jersey is the first state to attempt to mandate the strict "drug court" program, which is practiced nationwide. Yet in October, Christie vetoed the Good Samaritan bill, instead asking his administration to study the problem and report back in 18 months. The veto perplexed supporters.

"He's talking about second chances. That's exactly what the Good Samaritan bill did," said Roseanne Scotti, New Jersey director of the Drug Policy Alliance. "You can't get a second chance if you're dead."
Since Christie blocked the bill, 17 municipalities have called on the Legislature to override his veto. The bill passed the Legislature with bipartisan support, but GOP lawmakers have prevented override attempts on previous bills. The Democratic-led body must achieve a two-thirds vote in each chamber to override a veto. Scotti hopes the Legislature will succeed in an override, but she knows the odds are long. In the meantime, Sen. Joseph Vitale (D., Middlesex), a primary sponsor of the Good Samaritan bill, is cosponsoring a bill that seeks to make an opioid antidote, naloxone, more readily available. Sen. Richard J. Codey (D., Essex) is cosponsoring the bill. The Senate panel unanimously agreed to move the bill from committee Monday. Michael Drewniak, a spokesman for Christie, did not respond to a request for comment.
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Two-year MaineCare cutoff for opiate addiction drugs kicked in early January
Patients on Suboxone will need to prove the drug works to continue receiving it; those prescribed Methadone face a two-year time limit starting on Tuesday, January 1, 2013

Health officials say those who still need certain drugs to treat addiction won't be cut off entirely, even as a legislative bill aims to cut off treatment for some. Michelle Morin, a registered nurse at Merrimack River Medical Services in Portland, administers Methadone at a dosing window on Jan. 9, 2008. MaineCare coverage for Methadone and Suboxone is set to cease on Tuesday for treatment for those who have been covered for at least 24 months. A bill passed by the Maine Legislature established the 24 month lifetime limit. But a task force of medical providers, substance abuse treatment providers, government officials, and patient advocates have developed criteria for continued MaineCare coverage of medically necessary Methadone and Suboxone treatments. Rest of the story is available here.
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Change and the Serenity Prayer
By Fred Holmquist, Director of The Lodge at Hazelden

By now, the momentum of some of our one-year-at-a-time resolutions has abated. For most of us, initiated changes in life far outnumber sustained changes in life. Mark Twain's quote nails it:
"Quitting smoking is easy. I've done it hundreds of times."

Let's look at how the Serenity Prayer offers important distinctions for more productive use of our life energy, yet doesn't highlight the key element for a transformed life.

  The serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference are priceless reminders for more efficient and effective living. Yet, they don't include the distinction for addressing the greatest challenge to our spiritual growth in recovery. Made clear on page 62 in Alcoholics Anonymous is an additional condition we can't change. Beyond the seemingly hopeless state of mind and body that gets our attention in active addiction is the wisdom in "How It Works," that over-reliance on self blocks us from the spiritual solution: page 62 "…[the alcoholic] is an extreme example of self-will run riot, though they usually don't think so." We also learn that, "Neither could we reduce our self-centeredness much, by wishing or trying on our own power."

Whew! We have bodies that can't tolerate what our minds can't leave alone AND we have a spiritual malady that disallows us from doing anything about it on our own.

Application of the serenity prayer to this third element of Step One's lethal trifecta would emphasize the need for serenity and acceptance, because we can't change our over-reliance on self "much" on our own. By page 66, we've learned the emotions generated by this immutable imbalance of humanness are what shut us off from the Sunlight of the Spirit. Since self can't change itself for the same reason a hammer can't hit itself or a foot can't kick itself, neither serenity nor courage, nor the wisdom to know the difference will get us unblocked. So what's implicit in the Serenity Prayer but missing from its text? Essentially, it's to do the things I can, that will bring about the changes I can't. One of the subtle, but frequent, clues is on page 64 in the sentence, "Though our decision (in Step Three) was a vital and crucial step, it could have little permanent effect unless at once followed by a strenuous effort to face (in Step Four), and be rid of (in Steps Five through Nine) the things in ourselves that had been blocking us." We're told clearly to face what's been blocking us in Step Four (with the courage [read fearless] to change the things we can). However, the text doesn't say "and get rid of the things in ourselves which had been blocking us," but rather says, "and be rid of the things in ourselves which had been blocking us." Thus the practice of Steps Five through Nine is following the directions for doing the things I can which will bring about the changes I can't.

I am not suggesting that we change the Serenity Prayer. I am suggesting that we be mindful each time we say it that the miracle of sustained change is the byproduct of spiritual practice, much of which lies somewhere far beyond the serenity to accept the things I cannot change and the courage to change the things I can.
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One in three American adults have gone online to figure out a medical condition
Thirty-five percent of U.S. adults say that at one time or another they have gone online specifically to try to figure out what medical condition they or someone else might have.  These findings come from a national survey by the Pew Research Center’s Internet & American Life Project. Throughout this report, we call those who searched for answers on the internet "online diagnosers." When asked if the information found online led them to think they needed the attention of a medical professional, 46% of online diagnosers say that was the case. Thirty-eight percent of online diagnosers say it was something they could take care of at home and 11% say it was both or in-between. Rest of the story is here.
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Bringing gambling problems to light
As the casino boats were coming into its immediate area in 1993, the Illinois Institute for Addiction Recovery was beginning to treat compulsive gambling.  Coleen Moore, Marketing and Admissions Manager at the treatment organization, remembers when it began.  She explains, “What we were finding was that many of our clients who were in treatment for alcoholism, were coming back to us were saying, ‘Okay, I’m not drinking, but I’m going to the boat and I’m gambling. And I feel like I’m not in recovery.’”  After these comments, Moore says the staff really began to grasp the mechanics of gambling as an addiction.  They found that although there are some differences, the behaviors of a person with gambling issues look very similar to the experiences of someone suffering from alcoholism.  Click here to read the remainder of the story.
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Study: Replacing prison terms with treatment could save billions in criminal justice costs
Nearly half of all state prisoners are drug abusers or drug dependent, but only 10 percent receive medically based drug treatment during incarceration, according to a news release. Untreated or inadequately treated inmates are more likely to resume using drugs when released from prison, and commit crimes at a higher rate than non-abusers. The study, completed by researchers at RTI International and Temple University and published online in November in Crime & Delinquency, reports that the savings are driven by immediate reductions in the cost of incarceration and by subsequent reductions in the number of crimes committed by successfully-treated diverted offenders, which leads to fewer re-arrests and re-incarcerations. The criminal justice costs savings account for the extra cost of treating diverted offenders in the community. “Substance abuse among offenders continues to concern policy makers because of its high prevalence and its effect on criminal behavior,” said Gary Zarkin, Ph.D., vice president of the Behavioral Health and Criminal Justice Research Division at RTI and the study's lead author. “Given the obvious burden on the criminal justice system and society caused by substance abuse within this population, diverting offenders to effective and targeted substance abuse treatment leads to less drug use, fewer crimes committed, and costs savings.” The findings were based on a lifetime simulation model of a cohort of 1.14 million state prisoners representing the 2004 U.S. state prison population. The model accounts for substance abuse as a chronic disease, estimates the benefits of treatment over individuals’ lifetimes, and calculates the crime and criminal justice costs related to policing, trial and sentencing, and incarceration.  According to the model, if just 10% of eligible offenders were sent to community-based treatment programs rather than prison, the criminal justice system would save $4.8 billion when compared to current practices. Diverting 40% of eligible offenders would save $12.9 billion.  The authors also address a concern common with diversion programs, which is that instead of being incarcerated, offenders are released into the community where they may commit additional crimes. Their analysis showed an immediate, short-lived increase in crimes, however, by the end of the first year, fewer crimes were committed, generating cost savings.
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Access to Health Care Services for Addiction Will Improve Dramatically
Once the Affordable Care Act (ACA) is fully implemented in 2014, access to effective health care services for addiction will improve dramatically, according to Faces & Voices of Recovery. In an issue brief, the advocacy group describes how the new legislation will make it possible for many in or seeking recovery to be included in the health care system for the first time. Those who will benefit from the new law include people who were previously enrolled in Medicaid, and then were disenrolled; those who are coming out of the criminal justice system; and people who have not been able to afford insurance. Under the ACA, a single enrollment application will determine if you are eligible for either Medicaid or the state insurance exchange, based on your reported annual income. People who do not qualify for Medicaid will be able to buy affordable health insurance through state health insurance exchanges. These are marketplaces that will be available to people who are not covered through their employer’s health plan, and those who work for small employers who provide employees with multiple health plan options. The law guarantees that insurance companies will not be allowed to deny someone coverage or place a lifetime cap on what is deemed reimbursable because of a pre-existing condition. According to the brief, “The new policy regarding pre-existing conditions, already in place for children, has direct applications to the recovery community. Addiction to alcohol and other drugs (or a substance use disorder, as it is sometimes called) has been considered a pre-existing condition by many insurers, and used as a means to deny claims and a disqualifier for coverage. That will no longer be legal.” Read the entire issue brief for more information on addiction treatment and the ACA.
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Legalizing Marijuana Sends Wrong Message to Young People, Kerlikowske Says
Legalizing marijuana sends the wrong message to young people, R. Gil Kerlikowske, Director of the Office of National Drug Control Policy (ONDCP), said this week. “We are certainly not sending a very good message when we call it medicine and legalize it,” he told The Oregonian. ONDCP calls marijuana addictive and unsafe, especially for use by young people. Marijuana, which was recently legalized in Colorado and Washington, remains illegal under federal law. Kerlikowske pointed to a 2012 survey that found 7.4 percent of California drivers tested positive for marijuana use—more than for alcohol. In a recent ONDCP web post, Kerlikowske wrote, “it is clear that we’re in the midst of a serious national conversation about marijuana.”
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Substance Abuse May Have Long-Term Negative Effect on Sexual Performance
A new study suggests substance abuse impairs sexual performance in men, even after they stop using drugs or alcohol. Earlier studies suggested men spontaneously recover their normal sexual performance several weeks after they end substance abuse, MedicalXpress reports. The study included 905 men, 549 of whom had been diagnosed with addiction to alcohol, cocaine, heroin, marijuana, or a combination of substances. The men who were diagnosed with addiction had an average of one year of abstinence. The researchers found the men who had been addicted had a moderately to significantly impaired sexual performance, in the areas of sexual desire, satisfaction, arousal and orgasm, compared with men who had not been addicted. The researchers wrote in the Journal of Sexual Medicine, “These results seem to contradict those that argue that drug use only impairs sexual functioning temporarily. Moreover, they suggest that sexual functioning does not improve just by stopping drug use.”
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Lawmakers Ask Energy Drink Makers for Safety Information About Products
Three federal legislators have sent letters to 14 marketers of energy drinks, asking for information about the products’ ingredients and for studies showing their risks and benefits to youth, The New York Times reports. The Food and Drug Administration has received reports of 18 deaths and more than 150 injuries that mention the possible involvement of energy drinks, including 5-Hour Energy, Monster Energy and Red Bull. A new federal report found the number of emergency room visits involving energy drinks doubled from 2007 to 2011, reaching more than 20,000. The letters were sent by Senator Richard Durbin of Illinois, Senator Richard Blumenthal of Connecticut and Representative Edward Markey of Massachusetts to companies including Monster Beverage, Red Bull, Rockstar and Living Essentials, which makes 5-Hour Energy. The lawmakers asked the companies to explain how much caffeine was in their drinks. They also asked for studies the companies had run or underwritten on the effects of the drinks on children or young adults. “There is very clearly a lack of understanding about the health effects of energy drinks and their ingredients especially on children and adolescents,” Senator Blumenthal said in a news release. “Energy drink makers are mistaken if they believe they have escaped regulatory oversight to safeguard consumer health.” “Energy drink companies need to be clear with consumers about what they think their product is, what it contains, and what it can do,” added Representative Markey. “The broad claims made by these products and their blurred classification in the marketplace make it difficult for consumers, particularly young consumers, from making informed decisions about their consumption.”