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HEAVY DRINKING DULLS MIND EVEN AFTER YOU SOBER UP Memory, learning skills are hindered the next day, study finds By
Randy Dotinga HealthDay Reporter FRIDAY, Nov. 19 (HealthDayNews) -- It's no secret a night of heavy drinking can leave
you with a parched mouth, a ferocious headache and an unsteady stomach the next morning.
But it can also make it tough to learn new information or recall things you already know, a new study says.
Researchers from Northern Ireland say they've shown that hangovers contribute to memory problems and delayed reaction
time, even many hours after last call.
The findings may sound obvious, and indeed they "confirm what a lot of people observe about how they function after a
night out drinking," said Dr. Robert Cloninger, a professor of psychiatry at Washington University Medical School who studies
the effects of alcohol.
What's different about the new findings is that the bodies of most of the study participants had processed all the booze
from the night before. Even after their blood-alcohol levels had returned to zero, they still had trouble with basic tasks.
"That's significant because it suggests that if you went out drinking and allowed enough time so that your blood-alcohol
concentration was at zero by the time you went to class the next day, you could still have difficulty learning new information,"
said alcohol researcher Aaron White, an assistant research professor of psychology at Duke University. "These findings suggest
that alcohol can affect your ability to learn long after the effects of the drug have worn off."
The researchers enlisted 33 women and 15 men, all "social drinkers," to take part in their study. The subjects underwent
memory and coordination testing the mornings after either abstaining or drinking their usual amount of alcohol between 10
p.m. and 2 a.m.
The participants were hardly light drinkers. The women, on average, drank 10.6 "units" per evening when they were allowed
to drink; the average for men was 10.5. A "unit" was defined as a glass of wine, a half-pint of beer or a "measure" of liquor.
The findings appear in the November/December issue of Alcohol and Alcoholism .
The morning after drinking, the subjects performed worse on some tests of memory and reaction time than those who didn't
drink, although being hung over didn't hurt the performance of the drinkers in all the tests.
As expected, the drinkers didn't feel great, either.
"Participants reported hangover effects as measured in terms of fatigue, physical discomfort and emotional disturbance,"
said study co-author Adele McKinney, a research assistant at the University of Ulster.
The study didn't speculate about how hangovers contribute to lower performance on mental tasks. However, Duke University's
White said hangovers have a lot to do with the fact that alcohol simply isn't good for the body.
"People feel sick the next day primarily because they've poisoned their bodies the night before with alcohol," White
said. "It's a poison, and it just so happens to be a poison that gives us a nice buzz. But you pay for it. The body must devote
energy to processing and removing it."
Even when no alcohol is left in the body, people are still plagued by aftereffects such as fatigue, nausea and dehydration,
he said. "All of that is going to make it harder for you to pay attention, to feel like learning and stay awake," he added.
"Those things are going to impair your function."
What to do? Of course, you could decide not to drink or at least not drink too much. Downing a glass of water or another
non-alcoholic beverage between drinks will slow drunkenness and combat dehydration, White suggested.
But if you do drink too much, the best thing to do the next morning is to take an aspirin, White said. And simply wait
for time to pass.
More information
For more about alcohol abuse, visit the National Institute on Alcohol Abuse and Alcoholism ( www.niaaa.nih.gov target=new).
SOURCES: Robert Cloninger, M.D., professor, psychiatry, Washington University Medical School, St. Louis; Aaron White,
Ph.D., assistant research professor, psychology, Duke University, Durham, N.C.; Adele McKinney, research assistant, University
of Ulster, Northern Ireland; November/December 2004 Alcohol and Alcoholism
SCIENTISTS STUDY HOW NEUROGENESIS CREATES A NEW STATE OF MIND
The Dallas Morning News - November 22, 2004
The Dallas Morning News
(KRT)
SAN DIEGO - You may have killed some brain cells last weekend, but don't worry. More are on their way.
Every day hundreds of new nerve cells, or neurons, pop into existence in your overtaxed brain. They may not make up
for a lifetime of abuse, but they could help your brain in other ways, scientists say.
Newborn neurons may help you learn and remember better. They may fight brain ailments such as addiction and depression;
antidepressants may work partly because they trigger a flood of new neurons in the brain.
Scientists are unraveling the secrets of these baby neurons, hoping to learn what makes a healthy brain.
New research shows that exercise stimulates the birth of new neurons - but only if the mouse being studied actually
wants to exercise. Other findings suggest that drinking alcohol prevents new neurons from being born. And Dallas researchers
have found that drugs such as morphine mess with newly created neurons, causing them to divide abnormally and alter
the brain.
These and other discoveries may one day help you take better care of your brain, scientists said last month in San
Diego at the annual meeting of the Society for Neuroscience.
Researchers once thought that baby neurons could spring up only in babies: A person got new neurons until the age
of 2 or 3; after that, the brain's neurons died off over the course of a lifetime. Even in the healthiest person, tens
of thousands of neurons naturally self-destruct every day.
"If we were to hear all the neurons in this room dying," neuroscientist Theodore Palmer told a standing-room-only
crowd at the meeting, "it would sound like popcorn on a massive scale."
But five years ago, scientists discovered that the adult human brain could also make new neurons, a process known
as neurogenesis.
Neurons are born much more slowly than others die, and not all of the new ones survive. But scientists think that
adult neurogenesis could play a major role in brain health - if only they could figure out what that role is.
Newborn neurons inhabit at least two places in the brain - the olfactory bulb, which is involved in smell, and the
hippocampus, a tiny seahorse-shaped structure that is important in memory. Scientists focus in particular on the hippocampus
because it's linked to so many crucial brain functions.
For instance, rats with lots of new hippocampal neurons do better at learning new mazes than rats without, said Amelia
Eisch, an assistant professor of psychiatry at the University of Texas Southwestern Medical Center at Dallas.
"New neurons maybe equal new memory," she said. But the story is more complicated than that.
"It sounds simple: more neurons good, fewer neurons bad," Eisch said. "That's a good place to start, but it's a lousy
place to finish."
For instance, rates of neurogenesis go up after a stroke. But no one wants to have a stroke just to increase brain
cells.
Rather, scientists are working to uncover what causes neurogenesis.
One factor could be exercise. Earlier research had shown that mice allowed to run as much as they wanted on exercise
wheels had higher rates of neurogenesis. While training for a marathon, neuroscientist Leigh Leasure of the University
of Houston decided to study whether involuntary exercise has the same effect.
She had one group of mice run freely, trapped another group on a treadmill with a sponge at the back to keep them
moving, and let a third group remain sedentary. After three weeks, the most new neurons appeared in the brains of mice
that exercised voluntarily.
The study, although done in mice, could have implications for humans trying to exercise, Leasure said.
"Maybe what's important is for people to choose something they enjoy, not something that they are not really excited
about doing and have to force themselves to engage in," she said. "Maybe it's walking with your granddaughter after
dinner instead of slogging along on the treadmill."
But don't have too much wine with that dinner. New alcohol studies suggest that drinking hampers neurogenesis.
At the University of North Carolina, Kimberly Nixon and her colleagues have been studying what happens to the brains
of rats whose blood alcohol level reaches 0.30 percent and higher. "We call it the 'college football weekend' model,"
she said.
Even a single massive dose kept new neurons from forming nearly a month later, the scientists found.
But there is some good news: Avoiding alcohol allows your brain to recover somewhat. After just a week of abstinence,
rats that had been dependent on alcohol doubled the rate at which new brain cells were born, Nixon and Fulton Crews
reported in the Oct. 27 issue of The Journal of Neuroscience.
Using drugs can also seriously affect neurogenesis, Eisch has found with her UT Southwestern colleague Chitra Mandyam.
Morphine, heroin and nicotine cause fewer new cells to be born, Mandyam reported at the San Diego meeting. And newborn
neurons in the brains of morphine-addicted mice divide abnormally.
The work helps clarify how morphine affects the brain and may one day lead to new treatments for addiction, Eisch
said.
To find new neurons, scientists inject animals with a chemical that marks dividing cells. As seen through a microscope,
the newborn cells light up among a sea of older, dimmer neurons.
Scientists want to improve that technology to better understand how and when new neurons are born. More important,
they need to learn what the new neurons do once they get incorporated in the brain, Eisch said.
One day, new treatments for brain disorders could spring from basic research into understanding why neurons appear
where they do, and what they do once they get there, Eisch said.
"If you're the right neuron in the right place, you can make a world of difference," she said.
University of Vermont
Burning anxiety: New treatment targets smokers with panic disorder
Not everyone who tries to quit the habit on the Great American Smokeout Nov. 18 will have the same odds of success.
The 2.4 million Americans who have panic disorders not only smoke at a disproportionately high rate--about 40 percent
vs. 24 percent of the general population--they also have a harder time quitting and relapse more often. Another 5 percent
of American smokers--2.4 million more people--may develop panic-related symptoms or even panic disorder when they
try to quit. Interventions such as nicotine replacement therapy and counseling don't address their symptoms, but new
programs pioneered by University of Vermont psychologists are offering hope.
Research suggesting that smoking often precedes panic disorder and may increase risks of developing the malady led
Michael Zvolensky, assistant professor of psychology and director of UVM's Anxiety Health and Research Laboratory,
to pioneer new prevention and treatment programs now being duplicated at other institutions. Participants learn to deal
with their panic-related symptoms through gradual exposure, coping strategies and mentally correcting illogical fears.
"Once conditioning has happened, you can't undo it," says Zvolensky, who initiated the programs. "We don't try to
remove panic-related symptoms, but we offer an alternative model to teach people to tolerate and/or alleviate symptoms."
Smokers with panic disorder "appear to be super-motivated to quit," says Zvolensky, "but they also seem to have a
harder time quitting, and are more likely to relapse." That's not hopeful news, considering that more than 90 percent
of smokers in the general population who quit on their own and up to 85 percent who attend traditional treatment programs
relapse within a year.
Zvolensky believes that mental health professionals have largely ignored cigarette smoking. Little is understood
of how smoking relates to anxiety disorders other than panic disorder, but studies indicate that a history of heavy
smoking may increase the chance of developing a variety of emotional disorders.
As a result of his research in the United States and Russia, Zvolensky and his team are currently evaluating a brief
prevention program and a 16-week treatment protocol that targets smokers who are vulnerable to panic psychology. By
inducing panic symptoms through such methods as having patients hyperventilate or breathe CO2-enriched air, smokers learn
to tolerate panic symptoms and react differently to those sensations. For instance, they learn to recognize that a
racing heartbeat isn't the onset of a heart attack.
Citizens of Nova Scotia are trying out Zvolensky's treatment model through a collaboration with the Psychiatry Department
at Dalhousie University, and laboratories elsewhere are duplicating his studies, which have been documented in more
than 30 articles in peer-reviewed journals such as Addictive Behaviors and Clinical Psychology Review. Although long-term
data are not yet available, Zvolensky hopes his research will lead to targeted, more effective methods to help people
with panic sensitivities quit the habit - and in some cases, help them to avoid developing the disorder in the first
place.
ECSTASY LINKED TO MEMORY LOSS 3.10.2004. 13:37:17 People who swallow the party drug ecstasy may forget more
than just their inhibitions, with new research indicating memory damage.
A study by a clinical psychology PhD student says the popular drug affects the memory, especially in high pressure
situations.
The research, conducted over four years, compares the average memory performance of three groups of about 30 participants.
They were ecstasy users who hadn't used the drug in two weeks, drug users who don't take ecstasy and people who don't
use illicit drugs.
Researcher John Brown, from the Australian National University, says there were small deficits in the average memory
performance of ecstasy users compared with both other groups.
But he says another test found relatively large memory deficits.
SOURCE: Radio News
New study shows hope for treating inhalant abuse
GVG may reduce addictive effects of 'huffing'
UPTON, N.Y. -- A new study by scientists at the U.S. Department of Energy's Brookhaven National Laboratory suggests
that vigabatrin (a.k.a. gamma vinyl-GABA or GVG) may block the addictive effects of toluene, a substance found in many
household products commonly used as inhalants. These results broaden the promise of GVG as a potential treatment for a
variety of addictions. The study will be published in the December 1, 2004 issue of Synapse, available online September
30.
Inhalant abuse or "huffing" continues to grow as a serious health problem: According to the National Institute on
Drug Abuse, the number of new inhalant users increased from 627,000 in 1994 to 1.2 million in 2000. The chronic use
of inhalants has been associated with heart, liver, kidney, and brain damage -- and can even result in sudden death.
The Brookhaven Lab study demonstrates that animals previously trained to expect toluene in a given location spent
far less time "seeking" toluene in that location after being treated with GVG than animals treated with a placebo. This
elimination of conditioned place preference -- a model of craving in which animals develop a preference for a place where
they have previously had access to a drug, even when the drug is absent -- is similar to the aversion seen in Brookhaven's
earlier studies of GVG with nicotine and heroin.
"The findings of this study extend the potential value of GVG to treat addiction," says Stephen Dewey, the Brookhaven
Lab neuroanatomist who led the study. "More importantly, our results show promise in treating inhalant abuse as it continues
to grow as a problem among adolescents." There are currently no pharmaceutical treatments for inhalant abuse.
The study was conducted by putting rats through a series of conditioning tests. The tests were intended to condition
the animals to learn which chambers of a three-chambered apparatus contained toluene vapors. On the final day of the
study, scientists randomly administered either saline or GVG to the rats one hour before the testing. They then gave the
rats free access to the chambers with no toluene present while monitoring the animals' behavior.
Researchers found that animals treated with GVG spent 80 seconds on the side of the chamber where they had previously
received toluene as compared to the saline-treated animals, which spent 349 seconds in the "toluene" chamber. "GVG significantly
blocked toluene-seeking behavior in these rats," Dewey said.
Earlier research at Brookhaven Lab demonstrated the addictive nature of inhalants. A team led by Dewey found that
toluene elevates dopamine in the same regions of the brain as other addictive drugs, such as cocaine. The neurotransmitter
dopamine is associated with the activation of pleasure and reward circuits in the brain.
Inhalant abuse is among the most common forms of drug abuse, particularly among pre- and early adolescents, who inhale
or "huff" chemical vapors found in many common household products that are not generally thought of as drugs. Seventy-one
percent of inhalant users are 12 to 25 year olds, according to the 2002 National Survey on Drug Use and Health performed
by the U.S. Substance Abuse & Mental Health Services Administration.
Stephen Dewey and Jonathan Brodie, a psychiatrist at the New York University School of Medicine, have collaborated
at Brookhaven Lab on a large body of preclinical research on GVG as a potential treatment for addiction, and on two
small-scale trials of GVG in Mexico [one published http://www.bnl.gov/bnlweb/pubaf/pr/2003/bnlpr092203a.asp, one yet-to-be published]. Results from the preclinical and early clinical trials show that GVG holds promise as a
treatment for addiction to a variety of abused drugs (see: http://www.bnl.gov/pet/GVG/default.asp).
In October 2002, Catalyst Pharmaceutical Partners of Coral Gables, Florida ( http://www.catalystpharma.com), received an exclusive worldwide license from Brookhaven Science Associates, operator of Brookhaven National Laboratory,
for the use of the drug GVG for its application in treating drug addiction.
This work was funded by the Office of Biological and Environmental Research within the U.S. Department of Energy's
Office of Science and the National Institute on Drug Abuse.
Study: College Binge Drinking Worse Than Feared Wed Sep 8, 2004 01:30 PM ET
WASHINGTON (Reuters) - College students may down as many as 24 alcoholic drinks in a row when they party -- far more
than any previous studies have indicated, U.S. researchers said on Wednesday.The study by the Prevention Research Center
of the Pacific Institute for Research and Evaluation shows that university students, especially young men, may be drinking
even more heavily, and dangerously, than parents and educators feared.
Most research defines "binge drinking" as having five or more drinks in a row, without counting how far past five
the drinkers go.
The Berkeley, California-based nonprofit health research institute found that many of the 1,000 male college drinkers
surveyed said they had 24 or more drinks in a row.
"These are levels of drinking at which most men will have passed out or become comatose," said Paul Gruenewald, who
led the study.
"These are levels at which drinkers are at risk for the very serious problems posed by peak drinking, including alcohol
poisoning," Gruenewald added in a statement.
The study found that about 10 percent of the time, the drinkers had 12 or more drinks during a single session.
"When you see just how much some students may drink, it's easier to understand how these young people may suffer
from many alcohol-related accidents and injuries, some as simple as falling out of a dormitory window."
The study was funded by the National Institute on Alcohol Abuse and Alcoholism, one of the National Institutes of
Health. Women were not included in the study.
Fewer U.S. Kids Using Illegal Drugs, Report Says By Maggie Fox Reuters Thursday, September 9, 2004; 10:43
AM
Fewer U.S. teens are using marijuana, Ecstasy or LSD but more are bingeing on alcohol and abusing prescription
drugs, according to an annual government survey released Thursday.
While overall rates of illegal drug use have not changed, the use of some drugs decreased sharply, the 2003 National
Survey on Drug Use and Health found.
Among youths aged 12 to 17, 41 percent fewer said they had used Ecstasy in the past month and 54 percent fewer said
they had taken LSD. The survey found a 5 percent decline in the number of teens who had ever used marijuana.
The Health and Human Services Department quickly credited an advertising and education campaign. "It is encouraging
news that more American youths are getting the message that drugs are dangerous, including marijuana," HHS Secretary Tommy
Thompson said in a statement.
The annual survey by the Substance Abuse and Mental Health Services Administration found that 19.5 million Americans
aged 12 and older, or 8 percent of that population, currently use illicit drugs.
MARIJUANA STILL NO. 1 ILLEGAL DRUG Marijuana continues to be the most commonly used illegal drug, with 14.6 million
current users or 6.2 percent of the population. The survey found an estimated 2.6 million new marijuana users in 2002,
about two-thirds of them under the age of 18.
The Marijuana Policy Project, which supports the legalization of marijuana, said the numbers showed government policies
have failed.
"When you clear away the spin and look at the long-term trends, the real story is that three decades of drug use
surveys show that marijuana prohibition has completely failed to keep young people from using marijuana," said Steve Fox,
director of government relations for the group.
The SAMHSA survey found the numbers of binge and heavy drinkers did not change between 2002 and 2003. About 54 million
Americans 12 and older admitted to binge drinking, defined as having five or more drinks in a row, in the month before
the survey.
Young adults aged 18 to 25 were the likeliest binge and heavy drinkers.
An estimated 13.6 percent of people 12 or older -- 32 million people -- admitted to driving under the influence of
alcohol at least once in the 12 months prior to the interviews, down from 14.2 percent in 2002.
Misuse of three painkillers -- Vicodin, Lortab and Lorcet -- rose from 13.1 million to 15.7 million. Similarly the
number of people who said they had ever misused narcotic painkillers such as Percocet, Percodan, or Tylox rose from 13.1
million to 15.7 million people.
An estimated 2.3 million people said they used cocaine in 2003, 604,000 of whom used crack. One million used hallucinogens
including LSD, PCP and Ecstasy while an estimated 119,000 people used heroin. These numbers were all similar to 2002
rates.
The 2003 survey is based on in-person interviews with people aged 12 and older but it does not include active duty
military personnel, the homeless, prisoners or others in institutions.
Drug court programs get $42 million United Press International - September 08, 2004 WASHINGTON, Sep 08, 2004 (United
Press International via COMTEX) -- The Justice Department said Wednesday it has awarded more than $18 million to continue
special drug courts in 42 states.
The courts "integrate judicial supervision -- including sanctions with substance abuse treatment, mandatory drug
testing and transitional services to help non-violent, substance-abusing offenders break free of crime and drug addiction,"
the department said in its announcement.
The majority of the 31 drug court grants in 2004 ($13.16 million), were awarded to jurisdictions for drug court implementation.
Another 30 grants ($4.97 million) were awarded to enhance or expand existing drug courts.
Ten jurisdictions received more than $3.85 million to create family drug co urts, the department said.
Grants for up to $400,000 were available to implement drug courts and grants for up to $200,000 were available to
enhance existing drug courts.
A new report on drug courts, "Painting the Current Picture: A National Report Card on Drug Courts and Other Problem
Solving Court Programs," is accessible at ojp.usdoj.gov.
Early Puberty Linked to Early Substance Abuse Study found those who matured physically at younger age more likely
to experiment
By Amanda Gardner HealthDay Reporter
TUESDAY, Sept. 7 (HealthDayNews) -- Kids who enter puberty early are more likely to use and abuse tobacco, alcohol
and marijuana than those who physically mature later, mostly because their window of opportunity for experimentation is
wider.
Early puberty showed itself to be more important than age or school grade in influencing this type of behavior, claims
a study in the September issue of Pediatrics.
"Puberty marks the beginning of adolescence and the beginning of a much higher risk period for substance use and
abuse. For the individual, this is true whether puberty occurs early or late," explained study author Dr. George C. Patton.
"Where puberty occurs early that individual enters the higher risk period at an earlier point and hence the risk period
is extended downwards, widened if you like."
Patton is professor of adolescent health at the Centre for Adolescent Health at Murdoch Children's Research Institute
in Melbourne, Australia.
The findings raise the possibility that anti-substance abuse messages geared to younger kids might be helpful.
"Teens who develop early might be a risk group that is in need of more attention than we're currently giving," said
Suzanne Ryan, a research associate with Child Trends, a nonprofit, nonpartisan research group in Washington, D.C. "There
might need to be more vigilance by parents that if teens are developing earlier, just to be aware that they might be facing
a set of problems in terms of age this society doesn't think they're faced with."
This study, which was done in conjunction with researchers at the University of Washington in Seattle, surveyed 5,769
10-to-15-year-olds in both Washington State and in Victoria, Australia. Participants completed questionnaires about use
of tobacco, alcohol and marijuana. They also were asked to rate their own biological development by providing information
on breast and pubic hair development. After completing the survey, students in Washington received $10 in compensation
while students in Victoria received a pocket calculator.
The odds that a student had used a substance in his or her lifetime was almost twice as high in mid-puberty and three
times as high in late puberty. Recent substance abuse was about 40 percent higher for those in mid-puberty and more than
twice as high for those in late puberty, the survey found.
The odds of substance abuse were twice as high for those in mid-puberty and more than three times as high in late
puberty.
Those in the later stages of puberty were more likely to report having friends who were substance users, a relationship
that partly accounted for substance abuse.
The road to substance use and abuse seemed to be influenced primarily by "the tendency of the mature youngster to
seek out those who were substance users as friends," Patton said. "That was the main change affecting substance use. That
may have something to do with substance users being the 'cool' group to belong to." Other factors, such as a more distant
and conflicted relationship with parents, also increased the risk for substance use.
But if knowledge is power, this information should give parents and researchers more tools for prevention.
"First and foremost, the findings are telling us about the timing for investment in prevention of substance use.
Late childhood through to the mid-teens is a crucial phase for the timing," Patton said. "The focus we have often had
has been on health education of youth, but this study tells us something about why this is unlikely to work in a setting
where substance use is common. The strategies that are likely to be most effective are those that restrict access to
substance use within the younger teenage group. [This might include] enforcement of existing legal sanctions against use
and sale of substances to this age group and clear and communicated community standards around substance use."
TEEN DRUG TREATMENT JUMPS 65 PERCENT OVER DECADE, FEDERAL STUDY SAYS PR Newswire - August 31, 2004 WASHINGTON,
Aug 31, 2004 /PRNewswire via COMTEX/ -- The number of admissions to substance abuse treatment for adolescents ages 12 to
17 increased again in 2002, continuing a ten-year trend. These data were released today in the "Treatment Episode Data
Set: National Admissions to Substance Abuse Treatment Services 1992-2002" by the Substance Abuse and Mental Health Services
Administration (SAMHSA).
The new data show that the number of adolescents ages 12 to 17 admitted to substance abuse treatment increased 65
percent between 1992 and 2002. In 1992, adolescents represented 6 percent of all treatment admissions. By 2002, this
proportion had grown to 9 percent. This report expands upon data published in May in the "Treatment Episode Data Set
(TEDS) Highlights 2002."
The increase in substance abuse treatment admissions among 12 to 17 year olds was largely due to the increase in the
number of admissions in this age group that reported marijuana as their primary drug of abuse. Between 1992 and 2002,
the number of adolescent treatment admissions for primary marijuana abuse increased 350 percent. In 1992, 23 percent
of all adolescent admissions were for primary marijuana abuse. By 2002, 63 percent of adolescent admissions reported marijuana as
their primary drug.
"The youthfulness of people admitted for marijuana use shows that we need to work harder to get the message out that
marijuana is a dangerous, addictive substance," SAMHSA Administrator Charles Curie said. "All Americans must begin to
confront drug use -- and drug users -- honestly and directly. We must discourage our youngsters from using drugs and
provide those in need an opportunity for recovery by encouraging them to enter and remain in drug treatment."
Forty-eight percent of all adolescent treatment admissions in 2002 involved the use of both alcohol and marijuana.
Admissions involving these two substances increased by 86 percent between 1992 and 2002.
In 2002, more than half (53 percent) of adolescent admissions were referred to treatment through the criminal justice
system. Seventeen percent were self- or individual referrals, and 11 percent were referred through schools.
The TEDS report provides detailed data on admissions to substance abuse treatment for all age groups. The 2002 data
show that polydrug abuse (abuse of more than one substance) was more common among TEDS admissions than was the abuse
of a single substance. Polydrug abuse was reported by 55 percent of all admissions for substance abuse treatment in
2002. Alcohol, marijuana and cocaine were the most commonly reported secondary substances. For marijuana and cocaine, more
admissions reported these as secondary substances than as primary substances.
This new report provides information on the demographic and substance abuse characteristics of the 1.9 million annual
admissions to treatment for abuse of alcohol and drugs in facilities that report to individual state administrative
data systems. The report also includes data by state and state rates.
SAMHSA, a public health agency within the U.S. Department of Health and Human Services, is the lead federal agency
for improving the quality and availability of substance abuse prevention, addiction treatment and mental health services
in the United States.
SOURCE Substance Abuse and Mental Health Services Administration
CONTACT: Leah Young of the Substance Abuse and Mental Health Services
Administration, +1-240-276-2130
Brief Intervention Can Help Alcohol Abusers, Says the Harvard Mental Health Letter PR Newswire - July 30, 2004
BOSTON, Jul 30, 2004 /PRNewswire via COMTEX/ --
According to national surveys, nearly a third of Americans consume more than the FDA-recommended two drinks a day.
In the last two decades, treatment professionals have realized that reaching these potential alcohol abusers is important.
The August issue of the Harvard Mental Health Letter examines brief interventions for this large segment of the population.
Known as problem drinkers, this group probably accounts for most of the problems caused by alcohol, including family
problems, accidents, illness, and injuries. They rarely think of themselves as alcoholics or seek standard treatment for
alcoholism. However, recent studies suggest that a little advice and encouragement can help problem drinkers cut down
or eliminate their drinking. An estimated 75% of alcohol abusers recover without professional treatment or 12-step
groups.
The source of advice could be a physician, counselor, or lay person who is knowledgeable about alcohol. The helper
can ask about alcohol consumption and compare it to the norm. Too often, people define "moderation" as the amount they
themselves drink. The helper can provide a self-help manual, give a brief talk about the consequences of alcohol abuse,
suggest choosing a goal and keeping records of drinking patterns, and make professional treatment referrals if necessary.
Intervention can begin by screening large numbers of people for alcohol problems. The August issue of the Harvard
Mental Health Letter provides the following widely used questionnaire entitled CAGE (Cut down, Annoyed, Guilty, Eye-opener)
that has been estimated to identify 60-70% of alcohol abusers. A person who answers "yes" to even one of these questions
may have a problem that a closer examination will reveal.
* Have you ever felt that you should cut down?
* Have people annoyed you by criticizing your drinking?
* Have you ever felt guilty about your drinking?
* Have you ever had a drink first thing in the morning to steady your
nerves or get rid of a hangover?
FDA Approves New Treatment for Alcoholism
Associated Press - July 30, 2004 WASHINGTON (AP) - The government approved the first new drug to treat alcohol abuse
in a decade on Thursday, a medicine called Campral that promises to help ward off relapses.
Campral, known chemically as acamprosate, isn't for patients who are actively drinking at the start of treatment
or who abuse other substances in addition to alcohol, the Food and Drug Administration warned.
Exactly how Campral works isn't fully understood. But it is thought to somehow ease alcoholism withdrawal symptoms
by normalizing abnormalities in two brain chemical systems.
In a study comparing Campral to a dummy pill, more of the people using Campral were continuously abstinent throughout
their alcohol-abuse treatment, FDA said - although officials late Thursday couldn't provide the numbers to show how big
the difference was.
Most common side effects were headache, diarrhea, flatulence and nausea, FDA said.
Campral, made by France's Lipha Pharmaceuticals, has been widely used in Europe for years. In the United States,
there are two other FDA-approved drugs for alcohol abuse treatment: Antabuse, which reacts with alcohol to make the drinker
violently ill, and naltrexone, which blocks brains chemicals that make alcoholics feel good after a drink.
Campral will be distributed in the United States by Forest Laboratories, which did not immediately reveal a price.
TESTS DETECT SURGE IN METHAMPHETAMINE USE July 23, 2004 NEW YORK (AP) - Often made on the cheap in simple home-based
labs, methamphetamine is fast finding its way into the workplace, a new report indicates.
Employers who screen job applicants and workers for drugs saw the number testing positive for methamphetamine surge
68 percent last year, according to Quest Diagnostics Inc., the country's largest testing company, and usage is likely
to continue increasing as the potent stimulant spreads to the eastern U.S.
The report - tallying the results of more than 7 million workplace drug tests performed last year by Teterboro, N.J.-based
Quest - shows the methamphetamine positive rate jumped, along with a smaller rise in positives for opiates like heroin,
even as the overall number of workers failing tests stayed nearly unchanged at 4.5 percent.
``These increases that we're seeing are the largest increases of any drug or drug class for as long as we've been
tracking the individual categories'' of drug tests, said Barry Sample, director of science and technology for Quest's
workplace drug testing business.
Quest has been conducting its annual survey since 1988, but has only broken it down by drug category and type of worker
since 1997.
The surge in the use of amphetamines, a crystalline stimulant often called ``meth'' or ``ice,'' has prompted some
states to try to limit sales of the decongestant pseudoephedrine commonly used to make it. While big labs, most in California,
continue to supply most of the illegal methamphetamine consumed in the U.S., much of the growth has been fed by small,
home labs.
Last year, the Drug Enforcement Administration shut down 10,061 small meth labs, up from 8,063 in 2002. ``Clearly
it's emerged and is still emerging as a serious problem,'' said Ed Childress, a DEA spokesman.
The number of workers and job candidates testing positive for methamphetamine remains small compared to marijuana,
by far the biggest reason that people fail employer drug screenings, the Quest figures show. About 3 of every 1,000
workers now test positive for meth, compared to about 3 of every 100 workers testing positive for marijuana.
But while marijuana positives have stayed stable, amphetamine detection is soaring in the general work force. That
contrasts with airline pilots, workers in nuclear plants and others whose tests are required by the government, for
whom positive meth rates have increased only slightly.
In the general work force, though, usage appears to be rising at an even faster rate than in the past few years, when
annual increases in the number of positive drug tests ranged from 14 to 17 percent.
Employers who do screenings saw a 44 percent increase in positives for amphetamines, the category of drugs that includes
methamphetamines. Amphetamines now account for about 9.3 percent of all positive tests, more than double the rate in
1999.
Methamphetamine production and usage has its roots in southern California and was long most prevalent in western states.
But DEA statistics and Quest testing data shows it has spread to the middle and eastern portions of the country.
Quest found the number of workers testing positive for the drug has increased sharply in southeastern states like
Georgia and Alabama. Of the small labs broken up by the DEA last year, the largest number were in Missouri, with states
like Tennessee and Arkansas also hotbeds of production.
In addition to the rise in meth usage, Quest found that positive tests for opiates - including both heroin and the
painkiller morphine, which is contained in many prescription drugs - are also rising, up 25 percent in 2003 for the
general work force.
Overall, the share of workers testing positive for all types of drugs remained nearly unchanged - rising to 4.5 percent
from 4.4 percent. That is much lower than the 11 to almost 14 percent rate in the late 1980s, when employer drug tests
were not as common. The number of workers testing positive has fluctuated below 5 percent for the last six years.
Marijuana accounted for the largest share of the positive tests, with 2.96 percent of all workers testing positive
for the drug. Cocaine was the next leading cause of positive tests, with 0.74 percent of workers testing positive, Quest
figures showed. Both results varied little from 2002.
AMPHETAMINES DULL YOUR DESIRE TO WIN WEDNESDAY, July 21 (HealthDayNews) -- You really don't care if you win or
you lose when you're on amphetamines, researchers at Stanford University have found.
Doctors discovered that people on dextroamphetamines were less likely to get excited at the prospect of a cash reward
for successfully completing a task.
The subjects also were less likely to be upset at the possibility of losing, leading researchers to theorize that
such drugs might help "maintain motivation even in the face of adversity."
Magnetic resonance imaging (MRI) scans of the subjects' brains during the task revealed a selective damping of peak
activity in a region of the cortex known as the ventral striatum. Prior study has shown that region is activated by
anticipation of reward.
The subjects also were asked to rate their feelings of happiness, excitement, unhappiness, and fearfulness after each
task.
The study appears in the July 22 issue of Neuron .
-- Dennis Thompson
SOURCES: Neuron , news release, July 21, 2004
July 20, 2004 THIS IS YOUR BRAIN ON METH: A 'FOREST FIRE' OF DAMAGE By SANDRA BLAKESLEE NY Times People
who do not want to wait for old age to shrink their brains and bring on memory loss now have a quicker alternative - abuse methamphetamine
for a decade or so and watch the brain cells vanish into the night.
The first high-resolution M.R.I. study of methamphetamine addicts shows "a forest fire of brain damage," said Dr.
Paul Thompson, an expert on brain mapping at the University of California, Los Angeles. "We expected some brain changes
but didn't expect so much tissue to be destroyed."
The image, published in the June 30 issue of The Journal of Neuroscience, shows the brain's surface and deeper limbic
system. Red areas show the greatest tissue loss.
The limbic region, involved in drug craving, reward, mood and emotion, lost 11 percent of its tissue. "The cells are
dead and gone," Dr. Thompson said. Addicts were depressed, anxious and unable to concentrate.
The brain's center for making new memories, the hippocampus, lost 8 percent of its tissue, comparable to the brain
deficits in early Alzheimer's. The methamphetamine addicts fared significantly worse on memory tests than healthy people
the same age.
The study examined 22 people in their 30's who had used methamphetamine for 10 years, mostly by smoking it, and 21
controls matched for age. On average, the addicts used an average of four grams a week and said they had been high on
19 of the 30 days before the study began.
Methamphetamine is an addictive stimulant made in clandestine laboratories nationwide. When taken by mouth, snorted,
injected or smoked, it produces intense pleasure by releasing the brain's reward chemical, dopamine. With chronic use,
the brains that overstimulate dopamine and another brain chemical, serotonin, are permanently compromised.
The study held one other surprise, Dr. Thompson said: white matter, composed of nerve fibers that connect different
areas, was severely inflamed, making the addicts' brains 10 percent larger than normal. "This was shocking," he said.
But there was one piece of good news: the white matter was not dead. With abstinence, it might recover.
STRONGER POT MAY MAKE REEFER MADNESS REAL, U.S. FEARS Mon Jul 19, 2004 By Maggie Fox, Health and Science Correspondent WASHINGTON
(Reuters) - Alarmed by reports that marijuana is becoming more potent than ever and that children are trying it at younger
and younger ages, U.S. officials are changing their drug policies.
Pot is no longer the gentle weed of the 1960s and may pose a greater threat than cocaine or even heroin because so
many more people use it. So officials at the National Institutes of Health and at the White House are hoping to shift
some of the focus in research and enforcement from "hard" drugs such as cocaine and heroin to marijuana.
While drug use overall is falling among children and teens, the officials worry that the children who are trying pot
are doing so at ever-younger ages, when their brains and bodies are vulnerable to dangerous side effects.
"Most people have been led to believe that marijuana is a soft drug, not a drug that causes serious problems," John
Walters, head of the White House Office of National Drug Control Policy, said in an interview.
"(But) marijuana today is a much more serious problem than the vast majority of Americans understand. If you told
people that one in five of 12- to 17-year-olds who ever used marijuana in their lives need treatment, I don't think
people would remotely understand it."
JUMP IN POT-RELATED DETOX
The number of children and teen-agers in treatment for marijuana dependence and abuse has jumped 142 percent since
1992, the National Center on Addiction and Substance Abuse at Columbia University reported in April.
According to the report, children and teens are three times more likely to be in treatment for marijuana abuse than
for alcohol, and six times likelier to be in treatment for marijuana than for all other illegal drugs combined.
And it found the age of youths using marijuana is falling. The teens aged 12 to 17 said on average they started trying
marijuana at 13-1/2. The same survey found that adults aged 18 to 25 had first tried it at 16.
For National Institute on Drug Abuse director Dr. Nora Volkow the final straw was a report her institute published
in May in the Journal of the American Medical Association showing the steady growth in the potency of cannabis seized
in raids.
According to the University of Mississippi's Marijuana Potency Project, average levels of THC, the active ingredient
in marijuana, rose steadily from 3.5 percent in 1988 to more than 7 percent in 2003.
Volkow said many studies have shown the brain has its own so-called endogenous cannabinoids. These molecules are
similar in structure to the active ingredients in marijuana and are involved in a range of activities and emotions ranging
from eye function to pain regulation and anxiety.
GETTING INTO THE BRAIN
Brain cells have receptors -- molecular doorways -- designed specifically to interact with these cannabinoids.
The cannabinoids in marijuana may use these ready-made doorways into brain cells and this is why they cause a high
and reduce pain sensations. But Volkow believes the effects may go beyond the general feeling of well-being that most
marijuana users seek.
"I would predict that stronger pot makes the brain less likely to respond to endogenous cannabinoids," Volkow said
in an interview. The effects could be especially marked in young brains still growing and learning how to respond to
stimuli, she said.
While the research so far is inconclusive, Volkow believes that cannabinoids affect the developing brain and that
stronger pot, combined with earlier use, could make children and teens anxious, unmotivated or perhaps even psychotic.
As an analogy, Volkow said opiate addicts are more sensitive to pain, as their overuse of drugs have raised the threshold
at which the body responds and their own bodies produce fewer natural opiates.
NIDA is seeking proposals from researchers who want to investigate such possibilities for cannabis, she said.
Proponents of legalizing marijuana disagree with the official line. Krissy Oechslin of the Marijuana Policy Project
disputes the finding that cannabis products are stronger.
"They make it sound like the THC levels in marijuana were almost nonexistent, but no one would have smoked it then
if that was true," she said.
"And there's evidence that the stronger the THC, the less of it a person smokes. I don't want to say it's good for
you, but I'll say (more potent marijuana) is less bad for you."
While Walters stresses that drug abusers are patients and not criminals, he hopes to crack down more on producers.
And he says, there is a way to go in getting cooperation from local law enforcement officials. "For many in enforcement,
marijuana is still 'kiddie dope'," Walters said.
Walters is quick to stress he does not want to overreact.
"We shouldn't be victims of reefer madness," he said, referring to the 1930s propaganda film "Reefer Madness" that
became a 1970s cult classic for its over-the-top scenes of marijuana turning teens into homicidal maniacs.
'Crack babies' do better when placed with non-family caregivers Ever since the epidemic of cocaine and crack use that
began in the 1980s, researchers and doctors have been concerned about the development of children born to women who
used cocaine during their pregnancy.
Initially, research focused on the potential negative impacts of the drug itself, treating other factors associated
with maternal drug use as interfering. However, as researchers accumulated more information, many concluded that focusing
on the direct effect of the drug didn't provide a complete picture. In fact, in a letter to the editor of The New York
Times on Nov. 28, 2003, 28 leading researchers in the field questioned whether the widely reported "crack baby" syndrome
even exists.
In contrast to the lack of evidence regarding the toxic nature of cocaine itself on the developing fetus, the negative
effect of cocaine use on the quality of care parents provide to their young children has been consistently documented.
Thus, we studied how the type of care provided to toddlers who experienced prenatal cocaine exposure affected their
development.
We followed 83 cocaine-exposed and 63 non-exposed children and their caregivers from birth until the children turned
2. By that age, 49 of the cocaine-exposed children remained with their parents while 34 were cared for by other adults.
About half of the 34 children in non-parental care were cared for by relatives (kin care) and the rest by unrelated
individuals.
We found that prenatal drug exposure was not directly related to the children's developmental outcome at age 2. However,
we found that children in non-parental care, especially those in the care of people who were not relatives, had better
environments than those cared for by their parents and performed better in several developmental areas.
This improved performance existed despite the fact that these children experienced more problems at birth than the
children who remained with their mothers, including prematurity, and were born to mothers who were heavier cocaine users.
These results suggest that many of the negative outcomes observed in children of cocaine users may result from the
quality of caregiving during infancy rather than from the direct effects of the drug in utero.
If the environment is, in fact, more important in determining child developmental outcomes than prenatal cocaine exposure,
then developmental problems could be prevented and treated more easily. For instance, support could be provided either
through direct intervention with children, by supporting women in their recovery from substance abuse, and/or in helping
mothers improve their parenting skills. Finally, our study suggests that "kin" caregivers of cocaine-exposed infants
and toddlers may also need support and help with parenting. ###
SUBSTANCE ABUSE LINKED TO 1/4 OF VIOLENT CRIMES Fri May 21, 2004 By Patricia Reaney LONDON (Reuters) - People
with serious drug and alcohol abuse problems are linked to about a quarter of all violent crimes but many could be avoided
with better treatment, scientists said on Friday.
They found that 16 percent of crimes such as murder, robbery, assault and rape in Sweden between 1988-2000 were committed
by people who had been discharged from hospital for alcohol misuse and 10 percent were associated with drug abusers.
"It is likely you will find the same sort of figures in Western Europe and North America," Seena Fazel, of the University
of Oxford, said in an interview.
Fazel and Martin Grann, of the Karolinska Institute in Stockholm, studied the country's national crime register and
compared it with hospital discharges of people diagnosed with alcohol and drug misuse and psychoses.
Few countries, apart from Scandinavian nations, have such detailed population-based registers which are needed to
conduct such a study.
In addition to alcohol, abuse of amphetamines and opiates such as heroin, and use of multiple drugs were linked to
the most violent crimes.
"There needs to be more integration between the criminal justice system and mental health services because of this
close association between crime and people who leave hospital with drug and alcohol problems," said Fazel, who reported
his findings in the British Medical Journal.
"Using resources to treat people with these problems could be cost effective in terms of crime reduction," he added.
In Britain alone, drug related crimes cost the criminal justice system about 1 billion pounds ($1.8 billion) annually.
Fazel suggested that opportunities for treatment should be considered if a person with a history of alcohol or drug
abuse has been convicted of committing a violent crime.
"Probation officers and mental health professionals should continue to work more closely," he added.
The Effect of Parental Alcohol and Drug Disorders on Adolescent PersonalityElkins IJ, McGue M, Malone S, Iacono WG American
Journal of Psychiatry. 2004;161(4):670-676 This study sought to examine the relationship between parental substance use
and adolescent offspring personality. The authors chose to investigate personality because research suggests that it may be
a common mediating factor for alcoholism risk due to familial history. It is hypothesized that indicators of behavioral disinhibition
and negative emotionality may predict early onset of substance use and/or alcohol problems. It is important to identify possible
personality traits that predispose to substance use in order to create preventive interventions for teens at risk. The study
sample was derived from the Minnesota Twin Family Study, an ongoing longitudinal study of 626 twin pairs recruited at age
11 or 17 years. The adolescent cohort represented in this analysis consisted of 568 girls and 479 boys. Families had completed
a variety of assessments during the study. Personality was measured by the 198-item version of the Mutlidimensional Personality
Questionnaire, a self-report instrument. Substance-use disorders were assessed by clinician interview. Results showed that
for male and female teens, parental history of alcohol dependence was associated with greater negative emotionality, aggression,
stress reaction, and alienation, as well as lower well-being. Parental history of drug dependence/abuse was associated with
the teen traits of lower constraint, control, harm avoidance, and traditionalism, and with higher social potency. Reanalysis
by removal of teens already using substances did not change results, suggesting that the personality traits noted likely precede
onset of alcohol or drug use. The study authors reported their intentions to follow up at age 20 and 24 to observe whether
substance use was prospectively predicted by personality factors. Psychopathology Risk Transmission in Children of Parents
With Substance Use Disorders Clark DB, Cornelius J, Wood DS, Vanyukov M American Journal of Psychiatry. 2004;161(4):685-691
Children with paternal substance abuse history are at higher risk for conduct disorder, attention-deficit/hyperactivity
disorder (ADHD), major depressive disorder (MDD), and anxiety disorders. Many adult substance abusers have comorbid psychopathology
which may represent an additional risk factor for mental disorder in their offspring. The current study sought to clarify
transmission of risk to offspring of fathers with substance abuse. The sample population included 1167 children from 613 families
recruited through their biological fathers. Of the families, 294 had fathers with substance-use disorder (high risk) and 319
had fathers without substance use (low risk). Diagnostic assessments for both children and parents were determined by direct
clinician interview with structured instruments. Results showed that fathers in high-risk families tended to have comorbid
antisocial personality, major depression, and anxiety disorders. Low-risk fathers by definition had no mental disorders. High-risk
fathers also reported more childhood histories of ADHD and conduct disorders. High-risk-family mothers also tended to endorse
high rates of substance use, conduct disorder, MDD, and anxiety disorders. Offspring conduct disorder, ADHD, MDD, and anxiety
disorders were all significantly more common in the high-risk group. Furthermore, 3 combinations of comorbidity were commonly
seen in the youth: ADHD and conduct disorder; anxiety disorder and MDD; and ADHD and anxiety disorder. The authors concluded
that their study is consistent with disorder-specific risk transmission for psychopathology from parent to child. The genetic
and environmental factors involved in the transmission have yet to be determined. Such findings should have implications for
future preventive strategies.
Dopey Ads? (University of Texas at Austin) National anti-drug ad campaign might pique teens' interest in illicit
drugs, researcher says
You've seen the commercial: A man points to a skillet on a stove and says, "This is drugs." He cracks an egg and dumps
the yolk into the hot skillet. As the egg begins to fry and sizzle, he concludes, "This is your brain on drugs. Any
questions?"
This is one of dozens of bold and edgy anti-drug television ads that began airing in 1987 to curb rising drug use
among teens.
According to the Robert Wood Johnson Foundation, illicit drug abuse costs the nation about $414 billion annually and
takes close to 15,000 lives each year. Some studies suggest nearly half of all teens in the U.S. have tried illicit
drugs.
With the government spending about $195 million annually to purchase airtime for anti-drug ads and the Partnership
for a Drug-Free America (PDFA)-a non-profit coalition of advertising, media and public relations professionals-securing
more than $3 billion in donated media from broadcast, cable and radio networks since 1987, the anti-drug campaign is
the largest and most expensive in history.
There's a lot at stake. To validate the campaign messaging strategy and money being spent, a lot of research has been
conducted to demonstrate the ads' effectiveness. PDFA research findings show that anti-drug ads do connect with teens.
The ads can be recalled and the knowledge they impart is recollected. And some studies even show a decrease in intention
to use illicit drugs.
Differences That Make a Difference
However, Carson B Wagner, an assistant professor in the Department of Advertising at The University of Texas at Austin,
contends that inadequate research measures are being used to evaluate the effectiveness of anti-drug ads and that more
valid tests demonstrate that many anti-drug ads are having the wrong effects on teens, possibly increasing the likelihood
for experimentation with drugs.
"One of the most important lessons I learned in graduate school was that the best kind of research reveals 'differences
that make a difference,'" says Wagner. "In other words, the more counterintuitive the research finding, the more value
it has in the development of knowledge."
This approach led Wagner to uncover the curiosity-arousing effects of anti-drug advertising.
"Years ago, I noticed that every time a news story was broadcast about illicit drug use among teens, a small epidemic
would ensue," says Wagner. "Logic instructs us that news programs and anti-drug ads showing drugs in a negative light
should not lead people toward drugs."
Adding to this oddity was a 1999 study from the Institute for Social Research finding that-despite their enormous
exposure to anti-drug ads-tracking studies revealed that adolescents' perceived risk of illicit drugs had rapidly decreased
and their drug use had sharply increased since 1991.
While there'd been a significant amount of research done about the ways popular media can encourage drug use through
movies and music, there was very little research about the effects of anti-drug advertising. And the research that did
was able to demonstrate that that drug attitudes became more negative as a result of anti-drug ads. However, theory
and research on the psychology of curiosity suggested the opposite, and this nagged at Wagner.
Based on these observations, he hypothesized that teens exposed to anti-drug ads would express greater curiosity about
illicit drugs compared to teens not exposed to the ads-a highly counterintuitive possibility. After proving his hypothesis
in an experiment for his master's thesis while at the Pennsylvania State University, Wagner found himself defending
his thesis the day after Congress allotted $195 million per year to anti-drug ads.
The surprising research findings agitated many, and eventually, Congress requested that Wagner's research be presented
during its first review of anti-drug ad spending. Since then, a large government-sponsored survey examining the first
five years of the anti-drug campaign uncovered similar findings.
In the meantime, Wagner has conducted further research on the effects of anti-drug ads on teens. His latest asserts
there are better strategies to reduce drug use based, in part, on better research methods.
"The majority of the current anti-drug advertising research is flawed because it relies on research participants self-reporting their
attitudes in response to watching anti-drug ads," explains Wagner. "However, an immense body of research reveals that,
due to their conspicuous nature, self-reported attitude measures are highly susceptible to social desirability, especially
with regard to sensitive issues such as drugs."
In other words, drugs and drug-use can be an uncomfortable topic, and in order to conform to social norms, research
participants may intentionally-or unintentionally-misrepresent themselves when reporting their attitudes, resulting
in exaggerated estimates of anti-drug ads' effectiveness.
Measuring True Attitudes Toward Illicit Drugs
Unfortunately, when a teen is faced with a choice about drug use, the real-life situation may not lend itself to rational,
deliberate decision-making. Often perhaps, such decisions are made in an environment, such as a party, packed with peer
pressure. In circumstances like this, more often than not the decision can be made impulsively, and it's often based
on contextual cues: Is anyone else doing it? Are they enjoying it?
"When a situation forces someone to make a spontaneous decision, they will rely on their internal, automatic processes,
or gut feelings, about drugs," explains Wagner. "These associations stored in memory are called 'Strength of Association'
or SOAs. It is these SOAs that take over when we make quick decisions or aren't motivated to carefully think through
the choice at hand. And we need to better understand how SOAs work in order to create more effective anti-drug ads.
"Because of the social sensitivity associated with drugs, one of the most effective means to measure positive or negative
attitudes is to use response latency measurements of SOA," adds Wagner. "Rather than directly asking research participants
to express their attitudes about drugs, response latency SOA measures allow researchers to gauge people's attitudes
without their direct knowledge, thereby yielding a more accurate measure of the research participant's attitudes that
better predicts behavioral decision-making under various conditions."
This unobtrusive means of measuring attitudes was developed by psychologists in the 1970s, when self-report surveys
began showing the widespread disappearance of prejudice, which was incongruent with other measures of prejudice in society,
such as socioeconomic factors.
Essentially, response latency measurement involves recording the time it takes a research participant to categorize
a positive or negative adjective after being primed with a certain concept-in this instance, illicit drugs. The more
quickly the subject categorizes negative adjectives such as "bad" or "horrible," as opposed to positive adjectives such
as "good" or "wonderful," the stronger and more negative their association with the idea of illicit drugs.
Armed with a less obvious method of capturing audience's attitudes toward this sensitive topic, Wagner set out to
compare the results of self-report questionnaires versus response latency measures and determine if different measurement
methods would yield similar results.
One of Wagner's earliest research experiments measured attitudes about drugs among teens who had watched a series
of anti-drug ads produced by the PDFA. To gauge the persuasiveness of the ads, he used two different measures: self-report
questionnaires where people reported their attitudes toward drugs on scales anchored by positive and negative adjectives,
and response latency measures where people were instructed to categorize adjectives as quickly as possible.
The results showed that people who self-reported their attitudes after viewing the anti-drug ads expressed strong
anti-drug sentiments, as opposed to the weaker anti-drug sentiments measured in the response latency tests after viewing
the same anti-drug ads. These findings suggested that, compared to response latency measures, self-report measures exaggerated
the effectiveness of anti-drug ads.
"The results of the self-report versus response latency measures have implications for the on-going self-report, survey-based research
conducted by the Institute for Social Research's Monitoring the Future studies, which are often used to evaluate the Office
of National Drug Control Policy's Anti-Drug Media Campaign spearheaded by the PDFA," says Wagner. "Based on these findings,
the self-report surveys may have produced inflated claims of the ads' effects," he concludes.
Media Don't Tell Us What To Think, They Tell Us What To Think About
Wagner's most compelling finding based on more effective research methods has important implications for the strategy
behind producing and distributing anti-drug ads. Experimentation demonstrated that the higher the motivation to watch
an anti-drug ad-such as one that grabs your attention with an edgy, in-your-face message or runs during a prime, high-audience
timeslot-the more positive the teens' SOA toward drugs, meaning the more likely they would be to try drugs when faced
with a choice.
He uncovered this finding after conducting two experimental sessions with four conditions using the same six anti-drug
ads from the Partnership for a Drug-Free America. The experiment began with research participants receiving a brief
introduction to the series of ads. For half of the participants, the introduction was designed to maximize motivation
to watch the ads; for the other half, the introduction was geared to minimize attention. Half of the participants who
received each introduction were asked to remember seven-digit phone numbers as they watched, simulating the kinds of non-advertising
thoughts people often have during commercial breaks and further minimizing the amount of attention some participants could
pay to the ads. After viewing the anti-drug commercials, participants' SOA, along with several other ad-related responses, were
measured.
Among the many findings, Wagner's testing suggested that those who didn't pay close attention to the ads-whether unmotivated, remembering
seven-digit numbers, or both-showed significantly higher anti-drug SOA, while those who paid the most attention had the
least anti-drug SOA. In other words, the more attention research participants paid to the anti-drug ads, the weaker
their anti-drug SOA afterward, or the more open they were to the idea of drugs.
The study won the Top Faculty Paper award for the Communication Theory and Methodology Division of the Association
for Education in Journalism and Mass Communication, the largest and oldest mass communication academic organization.
"Keeping drugs on youths' agendas by using hard-hitting ads keeps them thinking about drugs," says Wagner. "And those
same ads can motivate people to pay attention, which can result in lower anti-drug SOA as compared to watching ads that
don't call attention."
These findings are a critically important paradigm shift for anti-drug advertising.
A Paradigm Shift for Anti-Drug Advertising
"The conventional anti-drug advertising strategy has been to produce highly visible, attention-grabbing ads, most
notably the campaign linking drug use and terrorism, and to place them at times when viewers are likely to be most attentive,
for example, the Super Bowl," adds Wagner. "Although this may be an effective political strategy, it's less likely to
achieve the goal of preventing illicit drug use."
The mindset behind conventional anti-drug advertising strategy, he says, assumes that people make decisions rationally
and deliberately. As a result, in order to persuade their audience, advertisers produce ads designed to grab the audience's
attention and make a compelling case against drug use so that viewers can use the arguments to protect themselves against
offers of drugs.
Based on his work in measuring SOAs, Wagner suggests that anti-drug advertisers consider not trying so hard to motivate
viewers to pay close attention, as depicted in the ad that links drug use to terrorism.
"Instead, they might devise creative techniques to keep the audience thinking unrelated thoughts as they watch the
ads so as to limit the attention viewers pay to the specific drug-related arguments," he says. "The more effective strategy
is to simply keep making associations between drugs and negativity repeatedly so that audiences learn those associations
as opposed to thinking about all the possibilities."
He also suggests that ad buyers consider placing anti-drug ads at times when opportunity and motivation to watch are
low, such as during TV shows with less consistent ratings, not those that have very dedicated audiences, such as the
MTV wrestling matches and the TV programs "Friends" and "Alias."
Wagner says the "What's Your Anti-Drug?" campaign, featuring teens talking about the activities they pursue instead
of drugs, is an excellent example of an ad not inadvertently arousing curiosity by limiting the focus on the anti-drug
argument and keeping viewers focused on something else, in this case alternative activities, such as skateboarding.
Not surprisingly, Wagner's research is starting to attract attention. Last year, Ogilvy & Mather, the agency involved
in assessing the effectiveness of the National Youth Anti-Drug Media Campaign, called on him to share his findings and
discuss the implications for the campaign.
Wagner's research highlights a need to rethink traditional assumptions about anti-drug ads, but further experimentation
with these less conspicuous SOA measures is necessary to support such a contention and to offer alternatives, he says.
Wagner's future research plans include developing response latency measures of curiosity that, similar to the SOA
measures, would be less sensitive to the influence of social norms and therefore more accurately assess possible counterproductive
effects of the ads. --
Top U.S. Physicians, Lawyers Tackle National Drug Policy: A Newsmaker Interview With David C. Lewis, MD Laurie Barclay,
MD April 22, 2004 — Editor's Note: Prominent U.S. physicians and lawyers have joined together in a nonpartisan organization,
Physicians and Lawyers for National Drug Policy (PLNDP), to advocate for a public health approach to federal and state substance
abuse policies. Since its inception in 1997, the group has believed that drug and alcohol policies must be based on evidence
rather than on politics, that prevention and treatment are more cost-effective than incarceration, and that substance abuse
should be afforded equal footing with other chronic, relapsing conditions in terms of access to care and insurance coverage.
The revised and expanded group, now incorporating members from the legal profession, met on April 20 at the National Press
Club in Washington, D.C., to discuss these and other issues, including the need for widespread alcohol screening in trauma
centers and emergency rooms. To learn more about PLNDP's agenda, Medscape's Laurie Barclay interviewed David C. Lewis,
MD, a member of the board of directors of the revamped group and a founder of the original group. Dr. Lewis is a professor
of medicine in community health and a professor of alcohol and addiction studies at Brown University in Providence, Rhode
Island. Medscape: What was the impetus behind the creation of PLNDP in 1997 and its recent revision and expansion? Dr.
Lewis: The creation of PLNDP in 1997 was really an expression of historical frustration, because the leadership of medicine
for almost a century had not been directly involved in the fashioning of drug policy. There were physicians during some periods
of that time who were involved, but basically it had become a criminal justice enterprise primarily. When the leadership gathered
for the first time in 1997, they struck quite a moderate and bipartisan tone saying that they wanted to really apply evidence
in evaluating drug policy, whether it be criminal justice approaches or medical and public health approaches. But they obviously
were looking for an increase in the attention we pay to public health approaches and medical approaches, which in fact meant
an expansion of treatment in a major way, both in and out of the criminal justice system. So that was really the impetus that
led to our formation. In our first meeting on a hot July day in the summer of 1997 and in two meetings at the Aspen Institute,
which were extremely well attended both by the core physician leadership group and by other leaders in law and business, we
set the groundwork for a consensus, which we followed in the ensuing years. I think that we did help turn more public
support and private support toward treatment and lessened the discrimination toward addicts and the incarceration of nonviolent
addicts. Polls in 1997 showed the public would just as soon send somebody to jail for their alcoholism or drug addiction as
send them to treatment, and by the time we finished that had changed, and I hope that we made a contribution to that change.
The new PLNDP group really came out of a discussion that we had with business, law, medicine and other health professionals.
It became clear that we would strengthen our message and be able to analyze the issues the policy insures better if we had
a combined effort with the legal profession. So this has been in the cards for some time. It has been discussed for at least
two years as part of our group, and now we have made a more formal organization with a board of directors and a leadership
council and two leading individuals, George Lundberg on the medical side and Professor Richard Bonnie on the law side. Medscape:
Why does the PLNDP feel that medical and public health approaches will be more effective than the criminal justice system
and interdiction in reducing illegal drugs? Dr. Lewis: From the evidence, that's what we ought to be doing. If you're talking
about what to do about nonviolent addicts who need treatment, quite obviously you can show that it's both the humane and cost-effective
way to provide treatment for them. There are a number of options people have now for treatment, including diversion from the
criminal justice system through something like drug courts and through other court procedures, but we felt that medical and
public health approaches were really underutilized compared to other approaches. We did a cost analysis of the cost of keeping
somebody in prison for a year, which was upwards of $30,000, versus the cost of treatment, which ranged from something like
$6,000 to something like $12,000 a year. Medscape: What specific medical and public health approaches does the PLNDP recommend,
and what would be the cost and funding base for these programs? Dr. Lewis: We haven't chosen specific projects yet; that
will come out of a meeting with the leadership council and the new board of directors. We certainly take a clear position
about what we think addiction is. Understanding that addiction is a disease does not absolve the addicted individual of responsibility
for their behavior, but their addiction should be given strong weight in the mitigation of punishment and as a basis of diversion
from the criminal justice system. So that's really the law statement part of our group. Sending people to prison does
not in itself help them recover, and the collateral consequence is that a criminal record creates enormous barriers to effective
recovery. I think it's fair to say that is an overall perspective of our law people and our medical people. Drug policy should
reflect the public health approach to prevention and treatment of substance abuse and should avoid excessive reliance on disproportionate
punishment. The United States should embrace an evidence-based, long-term strategy for controlling what is and will continue
to be an endemic social problem, taking into account the cost and benefits of every policy instrument deployed. Part of
this exercise in forming this group was to review a report from the National Research Council (2001), Informing America's
Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us, on the effectiveness of our current national drug policy —
a report that really pointed out how little of the policy is based on evidence. This report has influenced particular principles
that we're going to talk about when we launch the group. Medscape: What effects would there be from shifting funds away
from drug enforcement through the criminal justice system? Dr. Lewis: You would save money and be effective in preventing
crime. One of the encouraging things about the treatment of alcoholism and drug addiction, particularly if it's treated early,
is that it's a very effective crime preventer. Generally speaking, an investment of maybe $2,000 in one year in treatment
offsets about $19,000 the following year in criminal justice costs. One of the biggest cost offsets and benefits from treatment
is decreased crime, and that's very clear from a lot of different studies. There's actually a famous study in California talking
about how $7 are saved for California tax payers for every $1 invested in drug treatment. Most of those $7 are actually saved
from reduced crime, which happens almost immediately after the person enters treatment. You don't have to wait years and years
to see that benefit. Medscape: Does the PLNDP advocate changes in criminal law pertaining to possession, use, and trafficking
in illegal drugs? Dr. Lewis: We haven't advocated any specific changes in law; because that will depend on the leadership
council and the board of directors and a council of advisors, which we're setting up for a meeting this fall. We're still
straightening out the priorities we have in terms of what we ought to address early on, but whatever we do take up it will
be entirely consistent with the statement of principles that I just referred to. If you have this discussion with me or with
other leaders from the group in October, we could be very specific about the particular issues we're going to pursue. Medscape:
In what ways does the PLNDP hope to reduce regulation of addiction treatment programs, and what effects would this have? Dr.
Lewis: One of the consensus statements from the original group about excessive federal regulation referred mostly to methadone
maintenance, which is uniquely regulated. It's the most regulated drug in the United States. Physicians are not free to prescribe
it to addicts; there's all kinds of heavy duty regulation, and it's resulted in fairly large clinics as an option for people
receiving methadone maintenance. That needs to change. One of the changes that has happened is an introduction of another
maintenance drug, buprenorphine, which can be used in primary care and private practice settings. But that too is accompanied
by too much regulation limiting the number of addicts that each practice can treat. Medscape: If more insurers cover substance
abuse treatment on an equal footing to that of diabetes, hypertension, and other chronic diseases, what effect will that have
on overall insurance costs? Dr. Lewis: Like the initial PLNDP project, we're going to want insurance benefits for addictive
disease, and we're going to want them for a lot of good reasons. First, it's cost-effective; second, it's the right thing
to do; and third, treatment is as effective as it is for diabetes, hypertension, and asthma. An article in The Journal of
the American Medical Association shows that treatment outcomes for addiction are equal to those for other chronic diseases.
The problem with insurance is self-evident: insurance companies will simply say it costs too much to insure something.
They will also say they don't want any mandates. That's understandable; as an industry, of course they don't want any mandates.
But the interesting thing about the cost is how minimal the additional cost would be for insuring alcoholism and other addictions.
That is interesting compared to some of the cost of the other chronic diseases and even the cost of mental illness, which
has more obligatory inpatient care. So the annual increase for full parity for substance abuse treatment is estimated at about
a $5 increase in insurance premiums a year to cover this. But insurance companies are in a bind, because we don't have
a systematic healthcare system in this country, and people can shift insurance companies. Insurers are always worried about
whether they can enlarge their good-risk patients and decrease their bad-risk patients, so in our health system we penalize
people with chronic disease in terms of insurance. It's unfortunate, but we can't do anything about it. Even so, accepting
the system we have, fortunately the costs are really minimal compared to what the benefits are — just the offset in
the cost of other diseases and other conditions that could be prevented and other medical and surgical costs and hospitalizations
that could be prevented by early intervention for addiction treatment. The amount of injuries that go with alcoholism
alone are astronomical in terms of the cost, and alcoholism is in fact the leading cause of decreased productivity of all
the chronic diseases in the business world. So if you look at that it makes no economic sense for these conditions not to
be fully covered, but I think the insurance industry unfortunately has a reflex reaction — that's a mandate and we don't
want it. Even if it were a mandate, it's a mandate we should have, and it's not going to raise premiums enough to make a difference
in terms of the broadly insured public. But it will make a difference to thousands and thousands of people with these diseases.
Disclosure: One PLNDP member, George Lundberg, MD, is editor-in-chief emeritus of Medscape and editor of Medscape General
Medicine ( www.medgenmed.com). Reviewed by Gary D. Vogin, MD
19-Mar-2004 Contact: Michelle Person 301-443-6245 NIH/National Institute on Drug Abuse PREVENTION PROGRAM CURBS
DRUG ABUSE AMONG MIDDLE-SCHOOL YOUTH Results of a recently published study show that Project ALERT, a widely used school-based
drug abuse prevention program, successfully curbs the use of alcohol, cigarettes, and marijuana among middle-school
students.
Researchers from RAND Health conducted a randomized, controlled study in 55 South Dakota middle schools from 1997
to 1999. More than 4,000 seventh-grade students were assigned to Project ALERT classes or to a control group that was
exposed to drug prevention measures already in place at their schools. The analysis assessed drug use 18 months later.
Results showed that Project ALERT lessons significantly reduced the proportion of new cigarette users by 19 percent
and new marijuana users by 24 percent. When compared with the control group, marijuana initiation rates were 38 percent
lower for ALERT students who had not tried cigarettes or marijuana at the start of the study, and 26 percent lower for
higher risk students who had tried cigarettes. Scores reflecting overall alcohol abuse (binge drinking and drinking that
led to fights, for example) were 24 percent lower for all ALERT students.
Project ALERT is designed to modify student attitudes and behaviors toward alcohol, cigarettes, and marijuana. Students
are exposed to 11 lessons in seventh grade and 3 reinforcement or booster lessons in eighth grade. The lessons help
students identify and resist prodrug pressures and understand the social, emotional, and physical consequences of using
harmful substances.
The original Project ALERT was tested in urban, suburban, and rural schools in Oregon and California. Thus, it has
been shown to be effective for students in a variety of communities. The present study shows it also can be used successfully
in regions with comparatively high rates of alcohol dependence, binge drinking, and current smoking.
WHAT IT MEANS: Drug prevention programs are critical to school-based antidrug efforts and they can effect behavior
change in nonusers and in youth who already smoke and drink.
'I CAN'T HELP MYSELF' IS ADDICTION A MATTER OF CHOICE? By John Stossel April 21
- Watching TV, you'd think the whole country is addicted to something: drugs, food, gambling - even sex or shopping.
"The United States has elevated addiction to a national icon. It's our symbol, it's our excuse," says Stanton Peele,
author of The Diseasing of America.
There are conflicting views about addiction and popular treatments. So, we talked with researchers, psychologists
and "addicts" and asked them: Is addiction a choice?
Publicity about addiction suggests it is a disease so powerful that addicts no longer have free will. Lawyers have
already used this "addict-is-helpless" argument to win billions from tobacco companies.
BLAMING OTHERS FOR OUR "ADDICTIONS" IS POPULAR TODAY.
In Canada, some lawyers are suing the government, saying it is responsible for getting people addicted to video slot
machines.
Jean Brochu says he was unable to resist the slot machines - that he was "sick." He says the government made him sick,
and his sickness led him to embezzle $50,000. Now, he's suing the government to restore his dignity and pay his therapy
bills.
Psychologist Jeff Schaler, author of Addiction Is a Choice, argues that people have more control over their behavior
than they think.
"Addiction is a behavior and all behaviors are choices," Schaler says. "What's next, are we going to blame fast-food
restaurants for the foods that they sell based on the marketing, because the person got addicted to hamburgers and french
fries?"
Well, yes, actually. Two weeks after he said that some children sued McDonald's, claiming the fast-food chain made
them obese. They lost the first round in court, but they're trying again.
UNCONTROLLABLE IMPULSES?
"Impulse control disorder" is the excuse Rosemary Heinen's lawyer used to explain Heinen's shopping. Heinen was a
corporate manager at Starbucks who embezzled $3.7 million, which she then used to buy 32 cars, diamonds, gold, Rolex
watches, three grand pianos, and hundreds of Barbie dolls.
In court a psychiatrist testified Heinen was unable to obey the law, and shouldn't be given the seven-year prison
sentence she was facing. The judge, however, did put Heinen behind bars, sentencing her to 48 months.
The "helplessly addicted" defense seemed to work better for the Canadian gambler. The judge gave Brochu probation
and told him to see a psychologist. His mother paid back the $50,000 he stole.
Now Brochu and his lawyer are seeking $700 million on behalf of all addicted gamblers in Quebec, claiming the government
is responsible for getting them addicted, too.
CALLING ADDICTION A DISEASE
Many scientists say addicts have literally lost control, and that they suffer from a disease.
The National Institute on Drug Abuse calls drug addiction a "disease that will waste your brain." This is our government's
official policy. And government-funded researchers, like Stephen Dewey of Brookhaven National Labs, tend to agree.
They say their studies of addiction in monkeys and rats show that addiction is a brain disease.
"Addiction is a disease that's characterized by a loss of control," says Dewey.
Dewey takes his message to schools, showing kids brain scans that he says prove his point. He tells students that
addiction causes chemical changes that hijack your brain.
GENETIC DESTINY?
Dewey and other researchers say our genes predispose some of us to addiction and loss of control.
Researchers at Harvard University believe they may have found one of those genes in the zebrafish.
When researcher Tristan Darland put cocaine on a pad and stuck it on one side of a fish tank, fish liked the feeling
they got so much that they hung around the area, even after the cocaine was removed.
Then Darland bred a family of fish that had one gene altered. These fish resisted the lure of the cocaine.
Darland says this shows that addiction is largely genetic. "These fish don't know anything about peer pressure. They
either respond or they don't respond to the drug," he says.
At the Medical College of Wisconsin, Dr. Robert Risinger scans the brains of human addicts while they watch a video
of people getting high on crack. It's what they call a "craving" video. He then shows them a hard-core sex film.
The brain scans show the addicts get more excited by the craving videos. The drugs become more powerful than sex -
because addiction's a disease that changes your brain, says Dewey.
I asked Dewey if he was suggesting that drug users don't have free will.
"That's correct," he said. "They actually lose their free will. It becomes so overwhelming."
But if they don't have free will, how come so many people successfully quit?
IS THE DISEASE MESSAGE HARMFUL?
Addiction expert Sally Satel acknowledges drug addiction and withdrawal is "certainly a very intense biological process."
But she is one of many experts who say the addiction-as-brain-disease theory is harmful to addicts - and wrong.
She also thinks it's unhelpful to take away the stigma associated with drug abuse. "Why would you want to take the
stigma away?" she asks. "I can't think of anything more worthwhile to stigmatize."
"People need to get rid of the idea that addiction is caused by anything other than themselves," says James Frey,
author of A Million Little Pieces, a book about his experience as an addict.
Frey says he took just about every drug, from alcohol to crack. Yet Frey says he wasn't powerless. He scoffs at Dewey's
claim that addicts' brains compel them to keep taking drugs.
Many doctors agree, saying you can still choose not to take drugs, even if they do cause changes in your brain.
"You can look at brains all day," Satel says. "They can be lit up like Christmas trees. But unless a person behaves
in a certain way, we wouldn't call them an addict."
ENVIRONMENT AND CHOICE
In fact, some researchers cite experiments that they say prove that addiction is a matter of choice.
In Canada, researchers gave rats held in two different environments a choice between morphine and water. The rats
in cages chose morphine; the rats held in a nicer environment preferred the water.
Whether you get addicted also depends on how you're treated. At Wake Forest University, male monkeys lived together
for three months, and established a pecking order.
The monkeys who'd been bullied by the "boss monkeys" banged a lever to get as much cocaine as they could. But the
dominant monkeys, just by virtue of being dominant, had less interest in the drug.
"It's just like the human world," says Dr. Michael Nader, who conducted the experiment.
"Individuals that have no control in their job show a greater propensity for substance abuse than those that have
control," Nader says.
These comparisons suggest that addiction is a choice - not a disease that takes away free will.
The message from the treatment industry is that drug users need professional help to quit. What they seldom say is
that people are quitting bad habits all the time without professional help.
In fact, some studies suggest most addicts who recover do so without professional help.
For example, during the Vietnam War, thousands of soldiers became addicted to heroin.
The government tracked hundreds of soldiers for three years after they returned home. They found 88 percent of those
addicted to narcotics in Vietnam no longer were.
QUITTING IS THE RULE, NOT THE EXCEPTION
Even tobacco companies now admit nicotine is addictive, but does that mean it really denies smokers' freedom?
You seldom hear about those people who just quit ... on their own. No one's saying it's easy to quit. But it may surprise
you that quitting is not the exception, it's the rule. Most people who've used heroin or cocaine have quit. Since 60
percent of smokers have quit - that's 50 million Americans - it seems obvious that people do have free will.
But the drug research establishment insists most addicts are enslaved, that they don't have free will.
Dewey says just because 50 million people have quit smoking doesn't mean that an addiction to smoking isn't a disease.
Yes, it does, says Schaler. Schaler also says the use of the word "disease" is important, particularly in terms of
the money "addicts" are spending to get help. "If you say it's a choice not a disease, well then insurance companies
may not reimburse for that. ... If you say it's a choice, then the tobacco companies may not be slammed for millions of
dollars."
TREATMENT TRAP?
Some experts say the treatment industry is taking advantage of people in desperate situations.
"We're selling nicotine patches, we're selling the Betty Ford Center. We tell people, 'You can never get over an addiction
on your own. You have to come to us and buy something to get over an addiction.' It's not true, and it's dangerous to
tell them that," says Peele.
Former addict Frey agrees. His parents did pay for him to go to the expensive Hazeldon Treatment Center, but Frey
says he didn't buy into the messages the center offered in counseling and therapy.
"I stopped because I have my own 12-step program and the first 11 steps don't mean [expletive] and the 12th is don't
do it. And I didn't do it."
Frey and other former addicts say choosing is what it takes, making that decision.
"You can't tell people, 'This is all you're fault and there's nothing you can do about it,' " says Frey. "You have
to tell them, 'This is all your fault and you can make it all better if you want to.' " Frey says he still gets drunk.
Now he just does it differently. "I get drunk on walking my dogs, I get drunk on, you know, kissing my wife. I get drunk
on a good book. Getting drunk is just doing something that feels good." Web Resources The following Web sites offer
more information about the researchers and studies discussed in John Stossel's special on addiction, Help Me, I Can't Help Myself.
National Institute on Drug Addiction NIDA: < http://www.drugabuse.gov/NIDAHome.html>
Cannabis downgraded UK reclassification prompts dope debate. 29 January 2004 HELEN R. PILCHER
An This Thursday sees the downgrading of cannabis from a class B to a class C drug in Britain, putting it on a par
with tranquillizers and steroids.
Many people welcome the move, but it has also sparked controversy. Some caution that cannabis can trigger mental illness,
whereas others maintain that the drug is medically useful.
In Britain, drugs are grouped into three categories. Class A drugs include heroin and morphine, class B drugs include
amphetamines and barbiturates, and those in class C, now including cannabis, are judged to be the least damaging.
Under the reclassification, the possession, production and supply of marijuana are still illegal, but the penalties
are different. Adults found carrying the drug are now more likely to receive a warning than a prison sentence. And the
maximum prison sentence for possession has dropped from five to two years. Legally, this brings Britain in line with
some European countries such as the Netherlands, although in practice these laws are likely to be more strictly enforced
in Britain.
An estimated three million people in Britain take cannabis each year, some for medicinal reasons, but most for recreational
use. This includes one-quarter of those aged between 16 and 24.
Mind-altering
The long-term effects of smoking marijuana are uncertain. Some argue that cannabis can trigger schizophrenia, but
the evidence for this is controversial. A recent government report1 concluded that there is no clear causal link between
cannabis and mental-health problems. But Robin Murray of the Institute of Psychiatry in London disagrees. "Cannabis
nearly always exacerbates symptoms in people that already have mental-health problems," he says.
Murray has assessed cumulative data from five recent studies looking at cannabis use and schizophrenia. People who
use cannabis are twice as likely to develop schizophrenia than non-users, he concludes.
That said, the overall risk is low. Most people who smoke dope don't develop psychosis. But some may be more vulnerable
to the drug's mind-altering effects than others.
Marijuana use may have other adverse health effects too. Regular smokers - of cannabis or tobacco alike - are more
likely to develop lung cancer and respiratory problems such as asthma. And controversial studies have shown that the
drug can lower sperm counts in men and suppress ovulation in women1.
Healing powers
But the drug may have positive effects for some. Marijuana is thought to dull chronic pain and may ease the symptoms
of multiple sclerosis (MS), an incurable disease of the nervous system that causes spasms, pain and tremor.
In a recent large-scale trial, 60% of MS patients who took synthetic cannabis said it helped their mobility and eased
their pain and muscle stiffness. "It doesn't suit everyone, but it does suit some," says Clare Hodges, MS sufferer and
founder of the Alliance for Cannabis Therapeutics, a pressure group that lobbies for the medicinal use of marijuana.
About 10,000 seriously ill patients in Britain use cannabis to control their symptoms, says Hodges. Sufferers tend
to smoke or eat the drug.
The reclassification isn't expected to make much difference to those who already take the drug, as it has been readily
available for some years. But it may make life easier for those who use it medicinally, as arrests for cannabis possession
are expected to become less frequent.
"We hope that the prosecuting authorities will treat self-medicating patients sympathetically," says David Harrison,
a spokesperson for Britain's Multiple Sclerosis Society.
References
1. Advisory Council on the Misuse of Drugs report: The classification of cannabis under the Misuse of Drugs Act 1971
(1971). |Article|
Rise in Killings Spurs New Steps to Fight Gangs January 17, 2004 By FOX BUTTERFIELD - - NY Times LOS ANGELES,
Jan. 16 - At a time when other types of homicides have been falling for a decade, police officials and criminologists
are alarmed by one stubbornly volatile category, street-gang killings, whose spiraling numbers in recent years have
prompted aggressive new antigang tactics in Los Angeles and Chicago, the nation's youth gang capitals.
Gang homicides rose more than 50 percent from 1999 to 2002, the last year for which national figures are available,
but police officials say their strong efforts in Los Angeles and Chicago produced a sharp dent in the upward trend in those
cities last year.
Los Angeles, using new strategies pushed by Chief William J. Bratton, saw the number of gang-related homicides fall to
262 in 2003, from 374 in 2002, a drop of 30 percent. The total number of homicides fell to 506 in 2003, down from 645
in 2002, a 22 percent decrease.
But Chief Bratton told a national conference on gang violence here this week that this means more than half of Los
Angeles's killings are still being carried out by street gang members, an unacceptably high proportion. Gang violence,
he said, is "the emerging monster of crime in America."
Chicago was the homicide capital of the country in 2003. There, the new police superintendent, Philip J. Cline, using
many of the same tactics as Mr. Bratton, helped reduce the city's total homicides to 599 in 2003, down from 648 the
previous year. But more than 40 percent were still gang-related.
F.B.I. officials at the conference said they had evidence that gang members were now migrating out from Los Angeles and
Chicago to cities and smaller communities in many parts of the nation.
To underscore the threat, said James Alan Fox, a professor of criminal justice at Northeastern University in Boston, the
latest F.B.I. annual report on national crime statistics found that youth-gang homicides had jumped to more than 1,100
in 2002, up from 692 in 1999, the latest figures available.
Gang homicides "are a growing problem in many cities, and it is not a problem that we have any agreed on solutions to,"
Mr. Bratton said at the conference, which was attended by police chiefs and agents of the Federal Bureau of Investigation
from around the country. Mr. Bratton, who first became prominent as police commissioner in New York City from 1994 to
1996 when he presided over a large drop in homicides there, told the conference participants that gang members are "domestic
terrorists" who are now "taking more lives in this country than all the deaths from terrorism."
As an indication of the severity of the problem, Mr. Cline told the conference that over the past 80 years the Chicago Crime
Commission had recorded 1,000 homicides by members of the Mafia, or traditional organized-crime families. But in just
the last five years, Mr. Cline said, there have been 1,300 killings by street gangs in Chicago.
"The street gangs of today are worse than organized crime ever was," he said.
Some academic experts on gangs are skeptical that the latest police efforts will make much difference in the long run.
"This country has made very little progress against gangs in generations," said Irving Spergel, a professor emeritus at
the University of Chicago. Mr. Spergel has been evaluating gang-prevention work in six cities for the Justice Department.
"We still don't understand street gangs," Mr. Spergel said. "They are institutionalized, but very disorganized, and their
violence is usually not planned, like when a kid from one gang comes across a kid from another gang in his territory."
Malcolm W. Klein, a professor emeritus of sociology at the University of Southern California and the author of "The American
Street Gang," said Hispanic gangs had been around Southern California since the 1920's and black gangs since the late
1940's, but, he said, "nothing much has been done about them for decades."
One problem in dealing with these gangs, Mr. Klein said, is that they come in several forms, and what works with one type
of gang is counterproductive with others. For example, he said, smaller, less permanent gangs that specialize in selling
narcotics are susceptible to traditional police tactics like undercover buys and court injunctions ordering them away
from certain locations.
"But for the larger, traditional gangs, if you crack down on them, it only makes them feel stronger and gives them more
status," Mr. Klein said. "That's why they joined the gang in the first place."
He said the difficulty in cracking down on the big gangs is especially pronounced in California because the state's prison
system is in some ways run by inmates who belong to groups like the Mexican Mafia, the Crips or the Bloods, and when
they come home to Los Angeles, they are even more involved in their gang identity.
Another possible reason for the increase in gang violence, said Abel Valenzuela, a professor of Chicano studies and urban
planning at the University of California, Los Angeles, is the continued influx of young Hispanic and Asian immigrants
with their parents into areas like Los Angeles.
"The vast majority don't belong to gangs," he said. "But you have some practicing downward assimilation, with parents
that are poor and struggling to hold two or three jobs, so the kids have idle time and get involved with gangs."
When Mr. Bratton became police chief here, in October 2002, the police force was demoralized after the beating of Rodney
King, the subsequent riots and the discovery of a renegade unit that had been planting evidence. The gang units had
been disbanded, and the city signed a consent decree that provided for monitors to weed out wrongdoing by officers.
In the three years before Mr. Bratton's arrival, the homicide rate had risen 51 percent.
Mr. Bratton soon discovered that officers in some of his elite units had stopped working nights and weekends, when most
crime occurs. And the consent decree required that many had to work in marked cars and in uniform, and that they were
barred from using informants, all impediments to dealing with gangs.
So Mr. Bratton set a priority - gang violence - and relentlessly pushed his command staff to get more patrol officers
on the street and to make detectives work nights and weekends.
He also introduced Compstat, the computerized crime-tracking system that he employed successfully in New York.
It provides information on where crimes most often occur, and through it Mr. Bratton has been able to hold senior officers
accountable for lowering crime in their divisions.
Mr. Bratton even issued portable e-mail devices to all his top staff, giving them real-time information on every homicide,
as well as the per capita homicide rate in Los Angeles for the year, comparing it with the previous year.
Mr. Bratton has also been very visible, visiting dozens of homicide scenes and trying to enlist community leaders
and ministers in his campaign against gangs.
John Mack, the president of the Los Angeles Urban League, voiced strong support for Mr. Bratton's actions. Mr. Mack said
said he was encouraged that Mr. Bratton's plans, using improved computer software to target only the worst gang members,
"will be surgical and not a return to the bad old days of the L.A.P.D. profiling every African-American guy on the streets."
Mr. Bratton has also enrolled a new ally in his war on gangs: the federal government. The F.B.I. and the local United
States attorney's office have agreed to put more resources into prosecuting gang members in federal court, using racketeering,
drug and gun charges.
A major benefit, Mr. Bratton said, is that they will then be sent to federal prisons, outside of California, away from
fellow gang members.
Plagued by Drugs, Tribes Revive Ancient Penalty January 18, 2004 By SARAH KERSHAW and MONICA DAVEY - - NY Times BELLINGHAM,
Wash. - For generations the Noland family has led a troubled life on the Lummi Indian reservation here. The Nolands
have struggled with alcohol, painkillers and, more recently, crack. Seven family members are now jailed, several for
dealing drugs, on and off tribal land.
Their experience has been repeated hundreds of times on this sprawling, desperately poor reservation of 2,000 Lummi,
where addiction and crime have become pervasive. It is the reason that the Lummi tribe has turned as a last resort to
a severe and bygone punishment, seeking to banish five of the young men in jail and another recently released. It is
also the reason for evicting Yevonne Noland, 48, the matriarch of the Noland clan, from her modest blue house on the
reservation, because her son, a convicted drug dealer, was listed on the lease.
Banishment once turned unwanted members of a tribe into a caste of the "walking dead," and some people criticize it as
excessive and inhumane, more extreme than the punishments meted out by the world outside and a betrayal of an already
fragile culture.
But a growing number of tribes across the country, grappling with a rise in drug and alcohol abuse, gambling, poverty
and violence, have used banishment in varying forms in the last decade. Tribal leaders see this ancient response, which
reflects Indian respect for community, as a painful but necessary deterrent.
"We need to go back to our old ways," said Darrell Hillaire, chairman of the Lummi Tribal Council, shortly before
an early morning meeting on the reservation recently about the tribe's new campaign against drugs. "We had to say enough
is enough."
While the Lummi use banishment to root out drug dealers, other tribes, like the Chippewa of Grand Portage, Minn., are
using it to rid the reservation of the worst troublemakers and to preserve what they say is a shared set of core values.
Being banished can mean losing health, housing and education benefits, tribal rights to fishing and hunting, burial
rights, even the cash payments made to members of tribes earning hefty casino profits.
Recently, the Lummi have begun evicting the residents of households in which someone is charged with any drug-related
crime. That is what happened to Ms. Noland, who said she had never been arrested yet was evicted from her home on the
reservation because of her son's conviction for selling painkillers outside the reservation. She is now awaiting a ruling
from the tribal court on her appeal of that decision.
Although banishment was not being used when Ms. Noland's nephews and her son Robert Zamora committed their crimes, she
acknowledged that the threat might have deterred them. Still, she said, the punishment is too brutal. "Spiritually,
it's going to take your insides and turn them inside out."
She worries for her nephews and son. "They don't have an education," she said. "What are they going to do when they get
out there? And what is the white man going to do, with the tribe kicking us all off our own reservation? Can't they
see this is a catastrophe in waiting?"
Even within the Lummi Tribal Council, there is debate about how far the nation should go in its war on drugs, particularly
around the eviction policy.
"Would we propose taking someone's food or water?" said Perry Adams, vice chairman of the council. "It is a human right,
and for us to turn housing into a form of policing, I think we've gone too far. I think we had good intentions, but
does the tribe really have the right to take away membership in the nation?"
Tribal leaders estimate that at least 500 Indians on the reservation are addicted to painkillers or heroin and scores
of others to alcohol. Guns and violence plague some neighborhoods. Babies are born addicted to drugs. Ms. Noland's 15-month-old
grand-niece died two years ago of an overdose after eating an OxyContin pill that was dropped on the ground.
The loss of that baby was the turning point - when the tribe hit rock-bottom, leaders said. It came as an exploding
number of drug- and alcohol-related deaths were filling the Lummi cemetery, along a winding road that hugs Bellingham
Bay and is lined with fliers and flowers marking the spots where drunken drivers crashed and died.
There had long been a severe alcohol problem on the reservation, a scourge throughout Indian country. But things
took a terrible turn in the late 1990's, when OxyContin made its way to the reservation at a time when the tribe's long
history of living well off the land and water had virtually come to an end.
Bellingham Bay and the surrounding waters once brimmed with salmon, holding the riches that made the Lummi, known
as People of the Sea, one of the most successful fishing tribes. Many of those fishermen, with the salmon population shrinking
and the unemployment rate on the reservation skyrocketing, have turned to dealing drugs.
Tribal leaders estimate the value of the annual drug trade on the reservation is now $2 million, easily surpassing fishing
industry profits.
Mr. Hillaire, 49, and several others on the 11-member Lummi Tribal Council have made the fight against drugs and alcoholism
a focus over the past few years. He emphasized that the battle involves not just punishment but also education, prevention
programs and treatment, including intensely spiritual healing rituals for addicts.
Some Indians say banishment, while seemingly harsh, must be studied through the prism of tradition: It avoids bloodshed and
reflects tribes' community values.
"It's out of desperation," said Doug George-Kanentiio, who is a journalist for News From Indian Country, a national newspaper,
and a member of the six nations of Iroquois, some of which imposed banishments. "They could either reinforce the ancestral
discipline, or they go the American route, which has proven to be a failure."
Even in places like Grand Portage, where violence and drugs are relatively rare, Chippewa leaders have turned to banishment.
The tribal lands are policed by county law enforcement officers, but when a crowd got out of hand last summer, people
on the reservation demanded more than an arrest by the sheriff, more than criminal charges from a county prosecutor.
"We see ourselves here as kind of a big family, and so we needed to be part of the solution," said Norman W. Deschampe,
the tribal council chairman.
Just 350 members of this Chippewa band live on the banks of Lake Superior, in trailers and duplexes along roads rarely crossed
in the winter except by tourists headed to the casino and truckers hauling loads south to Duluth. Life is mostly quiet.
Front doors of homes are left unlocked, car keys are left in ignitions.
But one Saturday night in July, a group of people drove up to nearby Mount Maude and wound up talking and drinking
and fighting. Along the way, some pulled knives, vandalized cars and made death threats. Within days, another crowd packed
into the ordinarily empty tribal council meeting, demanding change.
No banishment provision existed in Grand Portage, but that night the council unanimously voted to remove a mother,
her two grown sons and a family friend in connection with the fight, and began writing a long resolution adding "exclusion"
to the band's rules.
If the legendary version of the Indian punishment seemed simple and stark, this one was complicated: legalistic and 12
pages long. On the list of failings that can lead to banishment are being in a gang, selling drugs, harming the band's
cultural items, disrupting a religious ceremony, unauthorized hunting or fishing and being banished from another reservation.
Still, the people of Grand Portage and Bellingham see banishment as a painful, last option. Both the Lummi and the
Chippewa have tried or are considering other actions, including drug education and treatment, curfews for young people
and seminars about gangs.
In Grand Portage, there have been no additional banishments since the tribe adopted the notion in October, and even Halloween
on the reservation - usually a time for egg-tossing and joy riding - went by without its usual harmless mischief.
John Morrin, a member of the tribal council, said he struggled over the banishments. He had always leaned, he said,
toward counseling and repair, not rejection. "This was a hard thing to do if you care about people," said Mr. Morrin,
who ultimately voted to banish the woman and her family, even though he said he was related to them.
The woman, Jacquelyn Jackson, now lives wherever she can. She sometimes sleeps on a cot in an elderly friend's shabby apartment
near downtown Duluth. Other times, she stays in a pile of blankets inside a tent in a dark basement of a relative's
girlfriend's house.
Ms. Jackson, 43, acknowledged that she behaved terribly that summer night. She was drunk and violent and wrong, she said
on a bitterly cold recent morning in Duluth.
But she said the punishment was too severe: losing her subsidized duplex on the reservation, losing her friends, losing
her way of life in an isolated, quiet place. "That's my land, too," Ms. Jackson said. "I've never been homeless in my
life. I'm never homeless. But I guess I am."
In her furious moments, she said tribal politics left her banished while others - those with friends or family members
on the tribal council - did wrong but were not sent away.
In sadder moments, she wondered aloud about what was happening back in Grand Portage. What were her friends doing?
What had become of the grill, microwave and fans she left in her house and was too afraid and embarrassed to go back
for?
"I cry every night because I want to go home," she said. "I miss that place so bad."
14-Jan-2004 Contact: Elena I. Varlinskaya, Ph.D. varlinsk@binghamton.edu607-777-7164 Binghamton University - SUNY Sandra J. Kelly, Ph.D. sjkelly@gwm.sc.edu 803-777-7610 University of South Carolina ADOLESCENT RODENTS EXPERIENCE MILDER HANGOVER EFFECTS THAN DO ADULT RODENTS
Prior research shows that adolescent animals are more sensitive to chronic alcohol exposure, with more pronounced
alcohol-related memory problems and brain damage than adult animals. A recent study has found that adolescent rodents
are less sensitive to the unpleasant consequences of an alcohol-related hangover, as measured by anxiety. Such a lack
of aversive effects could help establish a persisting cycle of drinking in adolescents, leading to a future of alcohol-related
problems.
Many people begin to experiment with alcohol use during adolescence, yet relatively little is known about alcohol's
effects during this critical stage of development. A study in the January issue of Alcoholism: Clinical & Experimental
Research uses rodents to assess hangover-related anxiety in both adolescent and adults. Findings indicate that adolescent
rodents experience less anxiety during the hangover phase, and recover faster from this hangover effect than do adult
rodents, and even show an increase in a specific form of social activity called "play fighting."
"We already know that adolescent rats are more resistant to the motor-impairing, sedative, and social-impairing effects
of alcohol than adults," said Elena I. Varlinskaya, associate research professor at Binghamton University and corresponding
author for the study. "In contrast, adolescent animals are more sensitive to chronic alcohol exposure, showing more
pronounced alcohol-related memory problems and brain damage than adults. Similarly, human adolescents are more vulnerable
to the chronic effects of alcohol consumption than adults. They become alcohol dependent in an average of seven months
after beginning regular drinking, whereas adults show their first symptoms of alcohol dependency only after three years
of regular drinking."
Anxiety, a condition of unsubstantiated feelings of apprehension, is one of the psychological signs of withdrawal
from alcohol in alcohol-dependent humans. The more commonly recognized signs of withdrawal are physiological in nature,
such as a rapid heartbeat, increased blood pressure, sweating, nausea, and even seizures. Anxiety may also appear in
non-dependent individuals following the ingestion of substantial amounts of alcohol; this phenomenon is generally referred
to as a "hangover."
"[Scientists have used] the social interaction test in rodents [as] a standard test of anxiety for many years," said
Sandra J. Kelly, professor of psychology at the University of South Carolina. In addition, alcohol researchers have
used both anti-anxiety and anxiety-provoking drugs in conjunction with alcohol consumption to help establish that increased
anxiety leads to the suppression of social interactions that would normally occur when two animals are placed together.
For this study, researchers examined changes in the social interactions of adolescent (110 male, 110 female) and adult
(115 male, 115 female) rodents at various times during the recovery period following injection of a single high dose
(4 g/kg) of either alcohol or saline.
"As expected, adult animals pre-exposed to alcohol interacted less with their partners than saline-exposed adult animals,"
said Varlinskaya. "This hangover-associated suppression of social interactions is reminiscent of the suppression in
social interactions seen during withdrawal from chronic alcohol. However, adolescent rats not only did not exhibit a
hangover-related suppression in social interactions, but they actually showed an increase in an age-specific form of
social activity called 'play fighting.' Thus, opposite to what is seen in adults, adolescents became more socially responsive
during the hangover phase. To our knowledge, this is the first time that such a dramatic age-related difference has
been reported in the effects of hangover on social activity."
Both Varlinskaya and Kelly noted that the negative aspects of a hangover can stop people from drinking alcohol, whereas
the lack of aversive effects may foster a sense of 'invulnerability' and even encourage adolescents to drink.
"We already know that adolescents drink in social situations, in large part to become more relaxed and sociable,"
said Varlinskaya. "Indeed, animal studies have shown that while under the influence of alcohol, adolescents show greater
facilitation of their social interactions than adults. The current results suggest that following a drinking episode,
adolescents experience a very unusual hangover effect that is manifested by an increase in social motivation and interactions
with peers. This increase in social motivation and desire to interact with peers may provoke adolescents to drink again
to gain the social benefits associated with drinking. An alcohol-associated enhancement of social interactions, both
during a drinking episode and during the post-alcohol recovery period, could help establish a persisting cycle of drinking
in at-risk adolescent individuals which may lead to dependency and a life-long history of alcohol-related problems."
Varlinskaya said future research will again use an animal model to investigate why adolescents and adults manifest
alcohol hangovers differently, focusing on brain pathways and systems.
Jan 12, 2004 TEENAGERS' USE OF ALCOHOL, DRUGS CAN BE CARRIED INTO ADULTHOOD Jane E. Allen LA Times Despite
the perception that people give up their hard-drinking, drug-taking teenage ways by middle age, it's only an illusion for
the youngest baby boomers. Big indulgers in high school tended to stay that way.
"The foundation for later substance use is set for most people by the time they finish high school," said Alicia Merline,
a University of Michigan psychologist who studied men and women who graduated from high school between 1977 and 1983.
She and her colleagues found that those who drank heavily in school were three times more likely to drink heavily
at age 35 than those who were high school teetotalers.
Those who had tried marijuana in school were eight times more likely to be using marijuana at 35 than those who hadn't
tried it by graduation.
The report was published in January's American Journal of Public Health. It was based on responses from 7,541 people
to the Monitoring the Future study conducted at the University of Michigan Institute for Social Research and funded
by the National Institute on Drug Abuse.
January 07, 2004 If cannabis is safe, why am I psychotic? By Steve Boggan
Weeks before the drug is downgraded from Class B to Class C comes new evidence that cannabis-induced psychosis is
the bigest problem facing inner city mental health services
THERE WAS SOMETHING horribly fast and terribly chilling about the onset of Steve Hammond's psychosis. His father Terry
remembers feeling a shiver down his spine when, sitting in front of the television, Steve turned to him with a strange
look in his eyes and said: "Why did you ring up the BBC?" "Of course, I told him I hadn't," Terry recalls. "But then
Steve said: 'Yes you did. You rang them up and told them I'm a lazy, useless bastard. And they've been broadcasting
it all day.'"
This was the start of three years of hell for the Hammond family; three years during which Steve, a bright, handsome
and popular 22-year-old, descended into madness and despair. For Terry it was the moment when he first saw the illness
for himself. For Steve it was a frightening repeat of an episode a few days earlier when, with no papers to roll a joint,
he ate a chunk of cannabis resin and collapsed in a nightclub toilet. "When I woke up I heard someone saying: 'It's
OK Steve, you can get up now, you're all right'," he recalls. "When I looked around, there was no one there.
This was the start of three years of hell for the Hammond family; three years during which Steve, a bright, handsome
and popular 22-year-old, descended into madness and despair. For Terry it was the moment when he first saw the illness for
himself. For Steve it was a frightening repeat of an episode a few days earlier when, with no papers to roll a joint, he ate
a chunk of cannabis resin and collapsed in a nightclub toilet. “When I woke up I heard someone saying: ‘It’s
OK Steve, you can get up now, you’re all right’,” he recalls. “When I looked around, there was no
one there.
“That’s when my voices started and I’ve had them ever since. I was so scared you can’t imagine.
I had voices coming from everywhere — the ceiling, the floor, in my head. It was the most frightening nightmare you
could imagine, except I was awake.” Steve is one of 210,000 people in the UK who suffer from schizophrenia, and
one of a growing number who believe cannabis caused their condition. Ten years ago psychiatrists would have disagreed with
him. But three weeks before the Government is due to reclassify cannabis from a Class B to a Class C drug, that view has changed
dramatically. Some of Britain’s most senior psychiatrists say the drug is now the “No 1 problem” facing
mental health services. Psychiatrists in inner-city areas speak of cannabis being a factor in up to 80 per cent of schizophrenia
cases, and mental health specialists are bracing themselves for an increase in the problem as reclassification is misinterepreted
as an assurance that the drug is safe. For years psychiatrists have noticed a high level of cannabis use among people
with psychosis, a generic term for schizophrenia, delusional episodes, manic depression and so on. But it had always been
regarded as a chicken and egg problem; sufferers tended to have behavioural problems as adolescents and were more likely to
use drugs to counter their often miserable lives. But all that changed two years ago when a group of researchers had the idea
of relating cannabis and psychosis to the Dunedin group, a continuing long-term study of 1,000 children — now adults
— in New Zealand. They found that those who used cannabis by the age of 15 were more than three times as likely to develop
illnesses such as schizophrenia. Since then, other control groups — including a 1987 survey of 50,000 conscripts
in the Swedish army and another study in Amsterdam — have been examined again with the drug in mind, and they have all
shown that cannabis use increases the likelihood of psychosis by up to 700 per cent. Robin Murray, a professor at the
Institute of Psychiatry and a consultant psychiatrist at the Maudsley Hospital in South London, took part in the groundbreaking
research that first solved the chicken-and-egg problem. His co-authored report, published a year ago, concluded: “Although
most young people use cannabis without harm, a vulnerable minority experience harmful outcomes. A tenth of the cannabis users
by age 15 in our sample developed schizophreniform disorder by age 26 compared with 3 per cent of the remaining cohort. Our
findings suggest that cannabis use among psychologically vulnerable adolescents should be strongly discouraged by parents,
teachers, and health practitioners. Policy makers and lawmakers should concentrate on delaying onset of cannabis use.”
In an interview with The Times, Professor Murray adds: “Unfortunately there were no experts in psychosis on the
committees (the Home Affairs select committee and the Advisory Council on the Misuse of Drugs) that advised the Government
on re-classifying cannabis. That’s not a criticism — at the time, no one thought there should have been. Since
then there have been at least four studies that show the use of cannabis can significantly increase the likelihood of the
onset of psychosis. “I would say this is now the No 1 problem facing the mental health services in inner cities.
In south London the incidence of psychosis has doubled since 1964. There is a terrible drain on resources. Not only are there
people suffering from psychosis who would not be in in-patient beds if they were not using cannabis, but use of the drug also
drastically reduces the chances of recovery. People who do improve go out on the streets, meet their old dealer, begin using
the drug again and relapse. We’re not saying that the Government shouldn’t reclassify cannabis — for most
people it causes no problems — but I am saying that if they’re going to do it they should warn people of the possible
downside.” The downside for Steve Hammond, now 25, was three months in a psychiatric ward and the loss of a promising
future. After three years of treatment, he lives with his parents at their home in Southampton. His paranoia is controlled
by drugs but he still hears voices, is unable to work and remains afraid to go out alone. “I can remember it starting
as if it were yesterday,” he says. “I wouldn’t want to wish that on anyone; it was terrifying. The voices
got worse and worse as the days and months went by. I became completely paranoid. I was convinced my mind had been taken over
by aliens; well, you would — how else could you explain the voices? “My mum and dad were great. They convinced
me to go into hospital. There was a bit inside me that said, ‘Steve you need help’. When I came out I felt better,
although my voices were still there. I tried different medications and eventually the doctors found one that suited me, that
did not give me bad side effects. My voices are still there but cognitive therapy has helped me to understand them. It made
me realise that they were really my own thoughts. The doctor explained to me about how the communication system in my brain
was not functioning correctly. He explained all about neurotransmitters. It seemed to make perfect sense to me. It was a revelation
and a fantastic relief that I had not been invaded by aliens. “I didn’t have a clue that cannabis could do
this; if I had, I may have had second thoughts, or at least not smoked so much. I thought it was perfectly harmless. If it
was public knowledge that cannabis can affect your mental health in this way, young people would be more switched on to recognise
the symptoms or they might make an informed choice not to start at all. “I have tried smoking cannabis since, but
it was terrible. As soon as I took a couple of puffs it made me feel instantly crazy. It was like putting on a switch. I don’t
touch the stuff now.” The voices and hallucinations in schizophrenia result from an excess of the brain chemical
dopamine. Drugs such as cannabis, amphetamines and cocaine increase the levels of dopamine in the brain. The Lambeth Early
Onset (Leo) service at Lambeth Hospital in south London has a first-onset psychosis ward where the damaging effects of cannabis
on dopamine levels are all too easy to see. Young men and women are brought in as early as possible to improve their chances
of recovery with anti-psychotic drugs. In a year, as many as 120 patients pass through the ward — the vast majority
admitting to regular cannabis use. “It would be wrong to say that cannabis alone causes psychosis,” says Paddy
Power, a consultant psychiatrist at the unit. “It’s a bit like saying someone had a heart attack because of a
stressful incident when they also ate too much fatty food, took too little exercise and smoked. In much the same way, using
cannabis can be a major contributory factor in the onset of psychosis. You are also at greater risk of developing psychosis
from genetic factors, early brain development problems, birth trauma and even migrating to another country. If you add cannabis,
then you have a dangerous mix. “Between 70 and 80 per cent of the people who present at our unit have a history
of cannabis use that has probably been a factor in the development of their psychosis. I wouldn’t say that should prevent
a reclassification of the drug, but it would be irresponsible of the Government not to marry that with an educational programme
— particularly for parents and young people — so users can be made aware of the risks in much the same way as
we are given health warnings over alcohol and tobacco.” The Home Office says its “Frank” anti-drugs
campaign includes advice on cannabis, but its efforts on education timed for the reclassification of the drug on January 29
could be called into question. It has commissioned the mental health charity Mentor to produce a million leaflets for distribution
a month after the reclassification — on a budget of just £50,000. Mentor’s chief executive, Eric Carlin, says
much more money is needed if the message that all drugs — including cannabis — are potentially dangerous is to
get to young people. “The area has been neglected,” he says. “We are not yet clearly making the point that
if you have a history of mental illness, or if you are pre-disposed to psychosis, you are playing Russian roulette by smoking
cannabis. Our job is to try to get that message across.” But isn’t reclassifying cannabis from B to C sending
a message in itself that the drug is safe? The Home Affairs select committee that recommended the reclassification in May
2002 thinks not, even in the light of the new evidence. David Winnick, one of the MPs on the committee, says its members stand
by their recommendation. “We would not change our view,” he says. “I believe we should be warning people
that they should not take any drugs, including cannabis. But we decided that to continue to criminalise everyone who takes
cannabis would be wrong. “As opposed as I am to people smoking nicotine, I would not be in favour of banning that.
All we can do is warn people of its dangers. There was no evidence to suggest that more people would smoke cannabis simply
because we reclassified it, and I don’t believe they will.” Terry Hammond, Steve’s father, disagrees.
“Of course it sends a message,” he says. “After Steve became psychotic I spoke to a lot of his friends about
cannabis and they all thought it was perfectly safe — and they felt that the reclassification confirmed that. Since
then I have been contacted by lots and lots of parents who believe cannabis was a major factor in their sons and daughters
slipping into psychosis. I have no doubt it caused Steve’s. “Most people who smoke cannabis will probably
suffer no harm whatsoever. But for some it will be disastrous. They could sink into Steve’s world. And I wouldn’t
wish that on anyone.” DEBATE Is cannabis safe? E-mail debate@thetimes.co.uk
Methamphetamine withdrawal associated with brain changes seen in mood disorders NIH/National Institute on Drug
Abuse Results of a new study indicate that people who have recently stopped abusing the powerfully addictive drug methamphetamine
may have brain abnormalities similar to those seen in people with mood disorders. The findings suggest practitioners
could improve success rates for methamphetamine users receiving addiction treatment by also providing therapy for depression
and anxiety in appropriate individuals. The study is published in the January 2004 issue of the journal Archives of
General Psychiatry.
"Methamphetamine abuse is a grave problem that can lead to serious health conditions including brain damage, memory
loss, psychotic-like behavior, heart damage, hepatitis, and HIV transmission," says Dr. Nora D. Volkow, director of
the National Institute on Drug Abuse (NIDA), National Institutes of Health, which funded the study. "Currently, no medication
exists to treat abuse or addiction to amphetamines or amphetamine-like compounds; however, drug counselors and other
health professionals have successfully used behavioral interventions to treat addiction. Treatment outcomes may improve
if associated mental conditions are addressed concurrently with addiction."
Dr. Edythe London and her colleagues at the University of California Los Angeles, the University of California Irvine,
and NIDA's Intramural Research Program used positron emission tomography--PET, a technology to image brain activity--to
compare glucose metabolism in the brains of 17 methamphetamine abusers who had stopped using the drug 4-7 days before
their participation in the study, and 18 nonabusers. The methamphetamine abusers averaged a 10-year history of drug
abuse that included consuming an average of 4 grams of methamphetamine per week. They said they had used the drug at least 18
of the preceding 30 days.
All participants responded to questions about their drug use, and underwent a PET scan to measure how their brains
used glucose while they performed an attention task. On the day of the scan, participants rated their symptoms of depression
and anxiety. The methamphetamine abusers also rated their cravings for the drug within 48 hours of the scan. The scientists
found that methamphetamine abusers reported higher ratings of depression and anxiety than nonabusers.
The PET scans showed that the two groups exhibited significant differences in glucose metabolism in specific brain
regions. In methamphetamine abusers, glucose metabolism was lower in brain regions linked to depressive disorders, depressed
mood, and sadness. It was higher in brain regions linked to anxiety and drug cravings.
"Improving our awareness of substance abuse as a condition that does not exist in isolation will contribute to more
effective prevention and treatment interventions," says Dr. Volkow.
Heavy, Long-Term Use of Cannabis Might Be Linked to Numerous Negative Features in American Users A DGReview
of :"Attributes of long-term heavy cannabis users: a case-control study" Psychological Medicine 01/02/2004 By Jill Taylor Long-term
heavy cannabis use is associated with several negative features on both objective measures and self-ratings of health and life
satisfaction, according to researchers from McLean Hospital, Belmont, Massachusetts, United States.
Despite multiple previous studies of heavy cannabis users, little recent information has been gathered to compare
attributes of long-term, frequent users with non-users or light users in the United States.
To provide more current data, Amanda J. Gruber, MD, and colleagues compared the attributes of 180 individuals, age
30 to 55 years, who were grouped on the basis of their history of cannabis use.
Based on telephone screening, the researchers identified 63 current long-term heavy users (who reporting lifetime
cannabis use of 5000 or more times and current use of 7 or more times per week), 45 former long-term heavy users (reporting
lifetime cannabis use of 5000 or more times and current use of up to 1 time per week), and 72 controls (reporting lifetime
cannabis use between 1 and 50 times).
Enrolled subjects entered a 28-day period of supervised abstinence from cannabis, and received evaluations including
administration of the Structured Clinical Interview for Diagnostic and Statistical Manual - Revision IV (SCID), the
Wender Utah Rating Scale (WURS), and the Attention Deficit Hyperactivity Disorder (ADHD) rating scale.
Results showed that in virtually all cases there was no statistically significant difference between current and former
long-term heavy users. Likewise, no significant differences were observed between heavy users (former and current user
groups combined) and controls regarding reported levels of income and education in their families of origin.
However, despite the similarities observed in familial income and education, heavy users reported significantly lower
educational attainment (P < .001) and income (P = .003) than controls.
Additionally, the majority of heavy users (66-90%) reported a "negative effect" in rating the subjective effects of
cannabis on cognition, memory, career, social life, physical and mental health and quality of life.
The researchers note that whether the findings would generalise to other cultures - where patterns of cannabis use
and associated behaviours may be very different - is not clear.
"Further studies are needed to better understand the direction of causality in these associations, since this information
will be important for developing better strategies to treat cannabis dependence," they conclude.
Psychol Med. 2003 Nov;33:8:1415-1422. "Attributes of long-term heavy cannabis users: a case-control study"
Prison Rates Among Blacks Reach a Peak, Report Finds April 7, 2003 By FOX BUTTERFIELD - - NY Times An estimated
12 percent of African-American men ages 20 to 34 are in jail or prison, according to a report released yesterday by
the Justice Department.
The proportion of young black men who are incarcerated has been rising in recent years, and this is the highest rate ever
measured, said Allen J. Beck, the chief prison demographer for the Bureau of Justice Statistics, the statistical arm
of the Justice Department.
By comparison, 1.6 percent of white men in the same age group are incarcerated.
The report found that the number of people in United States jails and prisons exceeded 2 million for the first time last
year, rising to 2,019,234.
That represented an increase of 0.3 percent in the number of people behind bars, in keeping with a slowdown in the prison
boom since the late 1990's, Mr. Beck said. But the number of inmates is still four times what it was before the enormous
increase in the prison population began in the mid-1970's.
The small growth in the overall prison population last year included larger changes in some states, the report found.
California, which has the largest state prison system, with 160,315 inmates, had a 2.2 percent decrease in its number of
prisoners in 2002.
Texas, which has the second-largest state prison system, with 158,131 inmates, had a drop of 3.9 percent, the report said.
New York, with the fourth-largest state prison system, had a decline of 2.9 percent.
In California, much of the decline stemmed from a ballot referendum two years ago that mandated treatment rather than
prison time for nonviolent drug crimes.
The drop in Texas was the result of efforts by state prison officials to save money by finding alternatives to imprisoning
parole violators, Mr. Beck said.
In New York the decline was the result of the drop in crime, he said.
The report found that last year, for the first time, the size of the federal prison system surpassed that of any state's,
with 161,681 inmates.
Some of this growth in the federal prison system was accounted for by the Federal Bureau of Prisons' takeover of prisons
operated by the government of the District of Columbia. But it also is part of the expansion of the federal prison system
in recent years as Congress has increased the number of federal offenses, including many drug crimes and gun possession
cases.
The report found that the overall prison population was relatively stable last year, but there was a 5.4 percent increase
in the number of people confined in local and county jails, with the number rising to 665,475. This was the largest
growth in the jail population in five years.
Generally, people sent to jail are awaiting trial or serving sentences of a year or less.
Mr. Beck said the growth in the number of jail inmates could be a result of the increase in crime last year, especially
property crimes like burglary, with more suspects now awaiting trial.
Alfred Blumstein, a criminologist at Carnegie Mellon University, said the report highlighted variations in the way
states use prisons in their approach to reducing crime.
Louisiana, for instance, had an incarceration rate of 799 inmates per 100,000 of its population, the highest rate
in the nation. But Maine, which had the lowest rate, incarcerated 137 inmates per 100,000 of its citizens.
Some of this disparity reflects a higher crime rate in Louisiana compared with Maine, Professor Blumstein said. "But
the disparity goes way beyond that into differences in punitiveness," he said.
"People tend to think of us as one nation with one culture," Professor Blumstein said. "I don't think the disparities
between states are widely appreciated."
Mr. Beck said that the 12 percent of black men in their 20's and early 30's in jail or prison was "a very dramatic number,
very significant."
That is just the rate on a given day, Mr. Beck said. Over the course of a lifetime, the rates are much higher, he said.
The Bureau of Justice Statistics has calculated that 28 percent of black men will be sent to jail or prison in their
lifetime.
American Association of Suicidology The elderly, alcohol dependence and risk factors for suicide Mood disorders,
financial difficulties, partner-relationships difficulties are contributing factors to potential for suicide SANTA
FE, NM - New research findings linking alcoholism as an established risk factor for suicide demonstrate the need for suicide
risk recognition and prevention efforts targeted to middle- and older-adults with alcohol dependence. Data also indicate
that increased age may serve as a marker for more chronic, treatment refractory alcoholism associated with greater risk
for suicide.
Presenters at two research seminars, "Risk Factors for Suicide and Medically Serious Suicide Attempts Among Alcoholics"
and "Moderators of the Relationship Between Alcohol Dependence and Suicide and Medically Serious Suicide Attempts"
will discuss new research findings in this area at the American Association of Suicidology's (AAS) 36th Annual Conference
on Saturday, April 26,2003 at 3:30 p.m. at the Inn at Loretto (Acoma North conference room) in Santa Fe, New Mexico.
Research results from the work of Kenneth R. Conner, Psy.D., MPH (2003 recipient of the prestigious AAS Edwin S.
Shneidman Award); Annette L. Beautrais, Ph.D.; and Yeates Conwell, M.D. (1994 Shneidman Award recipient) was gathered
from post-suicide psychological autopsies.
"This is the first case-control postmortem study of risk factors for suicide in alcoholics using comparable research
measures and methods," notes Dr. Conner of the risk factors-related study cited above. "The most important findings
were that interpersonal factors including marital and other partner difficulties were associated with suicide risk in
this population. This extends prior uncontrolled findings."
Additionally, Dr. Conner adds that the second moderators-related study examined factors that amplify risk associated
with alcoholism. Results showed that older alcoholics are at greatest risk, a finding not previously reported in a
statistically comparable study.
These two research studies were undertaken in part because while alcoholism is an established risk factor for suicide,
data on conditions that distinguish alcoholics at particularly high risk for suicide are meager. Other research findings
to be presented by Dr. Conner and colleagues include:
* Medically serious suicide attempters with alcoholism are more likely to have a mood disorder and financial difficulties
than control subjects - i.e. community dwellers with alcoholism but without suicide attempts. * Alcoholics who complete
suicide are older, and more likely to be male, have a mood disorder, partner-relationship difficulties, and other interpersonal
life events than control subjects. * Suicide prevention efforts in alcoholics must include a focus on depression as
well as interpersonal factors including partner-relationship difficulties.
Worried Pain Doctors Decry Prosecutions washingtonpost.com - December 29, 2003 Jeri Hassman, one of Tucson's busiest
pain doctors and a specialist in rehabilitation, was getting ready to inject a patient with a pain-killing treatment one day
in March when federal officials burst into her Calmwood clinic, took off her jewelry, put her in handcuffs and led her to
jail.
Months earlier, Drug Enforcement Administration agents had placed the doctor and some of her patients under surveillance
and had sent in undercover patients complaining of pain. They knew that large doses of morphine-based drugs such as OxyContin
and Lortab were showing up around Tucson in the wrong hands, and Hassman was suspected of writing some of the prescriptions
that made that possible.
Hassman was stunned. She does not deny that she prescribed a lot of powerful drugs to many patients, but she insists
she was following good medical practice when she did.
Her clinic has elaborate machinery to stretch and reset her patients' injured muscles and bones, but she is one of many
pain doctors who have become convinced that powerful prescription narcotics are often the only way to bring real relief to
chronic pain sufferers. She saw herself as a compassionate and cutting-edge physician.
In March, the two different worldviews collided. Hassman was charged with 362 counts of prescribing controlled drugs
outside the normal practice of medicine. A single mother of two, she faces up to 28 years in prison if her trial in February
ends in convictions.
"I never, ever imagined something like this was possible," said Hassman, 47, a Cornell and New York University graduate.
"When they came into the office to arrest me, it was like a bad movie that wouldn't end."
Hassman's confusion and dismay are shared by a substantial and growing number of doctors in the troubled field of pain
management.
In recent years, similar charges of illegally prescribing prescription narcotics, criminal conspiracy, racketeering and
even murder have been brought in dozens of states against scores of doctors who treat chronic pain with prescription narcotics.
At least two have been imprisoned, one committed suicide, several are awaiting sentencing, many are preparing for trial, and
more have lost their licenses to practice medicine and accumulated huge legal bills.
Top DEA officials say only a relative handful of doctors have gotten into trouble with the law and that all were prescribing
drugs outside medical norms in a manner that amounted to trafficking. The prosecutions, they say, have had a positive effect.
"There have been a number of very high-profile cases, and they have been a learning lesson to other physicians," said
Elizabeth Willis, chief of drug operations for the DEA Office of Diversion Control. "We think doctors are much more aware
of appropriate guidelines for prescribing OxyContin now."
But increasingly worried pain specialists say that although some doctors may be running narcotic "pill mills" and even
selling prescriptions for narcotics, many others who have been arrested appear to be responsible physicians.
Their crime, it seems, is that they were supplying their chronic pain patients with sometimes large numbers of prescriptions
for controlled but legal medications to treat their pain. The result, the doctors say, is that the established medical use
of opium-based drugs for pain is becoming criminalized by aggressive drug agents and zealous prosecutors.
Adding to their concern, the official rhetoric has escalated to the point that federal and state prosecutors often accuse
arrested doctors of being no different than drug kingpins or crack dealers. After the indictment in September of McLean pain
specialist William E. Hurwitz, a prominent and controversial doctor accused of running his practice as a criminal enterprise
and prescribing OxyContin illegally, Attorney General John D. Ashcroft said the arrest showed "our commitment to bring to
justice all those who traffic in this very dangerous drug."
Some pain doctors are organizing to push back, and in recent months a loose national movement has been formed to contest
what some call the "war" being waged against pain doctors, pharmacists and suffering patients. A new group called the Pain
Relief Network is organizing a march on Washington in April to protest the prosecutions and has hired an attorney to develop
a legal strategy for appealing some of the convictions.
"Fifteen years of progress in treating patients in chronic pain could really be wiped away if these prosecutions continue,"
said Russell K. Portenoy, a pain specialist at Beth Israel Medical Center in New York who is considered one of the fathers
of modern pain management. Since the mid-1980s, Portenoy has been advocating the use of morphine-based drugs to address what
he considers to be the widespread, unnecessary and even cruel undertreatment of chronic pain.
"Treating people in pain isn't easy, and there aren't black-and-white answers," he said, agreeing that some doctors have
not been sufficiently careful about potential problems with addiction and diversion of drugs. "But what's happening now is
that the medical ambiguity is being turned into allegations of criminal behavior. We have to draw a line in the sand here,
or else the treatment will be lost, and millions of patients will suffer."
According to pain specialist Rebecca J. Patchin, a board member of the American Medical Association, an estimated 50
million Americans live with chronic pain. She says almost half of all Americans will seek care for persistent pain sometime
during their lives, but that many will not receive the treatment they need.
"Doctors hear what's happening to other physicians," she said, "and that makes them very reluctant to prescribe opioids
that patients might well need."
Fear of Addiction
Narcotics have long been used to relieve pain, and they have also long been a major concern for law enforcement. Although
natural and synthetic opioids such as morphine, codeine and oxycodone have been proved to reduce pain, they also can cause
addiction and all the problems that come with it.
Until the mid-1980s, the law enforcement concern trumped the therapeutic value, and opioids were not widely used outside
hospitals. But then research into narcotic pain relief began to show surprising results: that people in pain generally did
not become addicted to the drugs, and that many could return to near-normal life with careful narcotic treatment.
These insights led to the development of new morphine-based products such as OxyContin, a narcotic formulated to be released
over 12 hours and so better suited for pain relief. The maker of OxyContin, Purdue Pharma, actively advertised the drug to
doctors when it was introduced in 1996 and said it could not be abused because of the capsule that surrounded the active ingredients.
But Purdue Pharma was wrong about that, and by 2000 OxyContin had become a significant drug problem in many parts of
the country, especially in rural areas. Scores of deaths and thousands of emergency room visits were attributed to overdoses
from OxyContin capsules that had been broken open and the contents snorted or injected by addicts and recreational users.
Media reports of those deaths and of the spread of OxyContin abuse through sometimes improper prescribing led to a 2001
directive by the Drug Enforcement Administration to "target individuals and organizations involved in the diversion and abuse
of OxyContin."
Doctors, and sometimes their support staff, quickly became the targets of choice. The DEA also began to limit the amount
of oxycodone (the active ingredient in OxyContin) that companies were allowed to manufacture, and total production declined
by about 25 percent from 2001 to 2002.
As DEA officials see it, the medical community needs to get much better control over narcotic prescribing. The agency
has met frequently with societies representing pain doctors and pain medicine and has encouraged them to expand narcotic-use
training for physicians -- which all agree is woefully inadequate. The agency often says that it supports the legitimate use
of prescription narcotics for chronic pain sufferers and has agreed to some general guidelines worked out with those groups.
But the DEA also is the agency targeting pain doctors who write frequent narcotic prescriptions and collecting information
leading to arrests. And as many doctors have learned, the government does not require evidence of what is normally considered
criminal intent to bring charges.
"We don't have to prove extra money is being made or doctors are getting favors for prescribing," Willis of the DEA said.
"What we have to prove is that they are operating outside the course of legitimate medical practice."
That standard, however, is ever-changing, and one that is generally set by state medical boards, rather than by any single
national agency. The standard is also broad, leading to prosecutions such as the one against Hassman in Tucson. In the federal
criminal complaint against her, the sole allegation is that she prescribed controlled substances "not being in the usual course
of professional practice and not for any legitimate medical purpose." The Arizona U.S. attorney's office declined to discuss
the case.
The broadness of the medical care standard has led to drug charges against entire practices (such as the seven-doctor
Comprehensive Care and Pain Management Center in Myrtle Beach, S.C.), murder charges against a California doctor who prescribed
OxyContin for a woman who had high levels of the drug in her system when she was killed as a passenger in an auto accident,
and multiple murder charges against a Roanoke doctor for prescribing narcotics misused by patients, resulting in overdoses.
Pharmacists, doctors' office managers and receptionists have been charged as well.
In all, the DEA statistics show that the agency has opened 406 cases of OxyContin trafficking alone since 1999 and made
464 arrests. The number of investigations and prosecutions of doctors soared in the late 1990s as the problem of OxyContin
and prescription drug abuse grew, but the DEA says the number of new cases declined this year. Pain management leaders, however,
say that they have not detected any easing of law enforcement scrutiny, and they say the severity of the charges brought against
doctors has increased steadily.
The prosecutions have been aggressive -- and tenacious. When 1999 murder charges against Harvard University-trained doctor
Frank Fisher and two pharmacists were thrown out by a California judge, prosecutors filed lesser charges. They, too, were
dismissed early this year. In Roanoke, pain doctor Cecil Knox was acquitted last month of most charges against him related
to prescribing narcotics, and the other charges ended with a hung jury. The local media reported that only one juror held
out against acquitting Knox on the three most serious charges of prescribing narcotics that killed or injured patients. Federal
prosecutors said they will retry the doctor on those and other charges.
Because of the sometimes complicated legal issues involved and some doctors' fears of being targeted, few medical societies
have publicly challenged the prosecutions. The exception is the Association of American Physicians and Surgeons, a national
organization of 4,000 members dedicated to the "sanctity of the patient-physician relationship." The group is working for
congressional hearings on the pain prosecutions and will participate in the protest in Washington in the spring.
That protest is being organized by Siobhan Reynolds, founder of the Pain Relief Network and a caregiver for a chronic
pain sufferer.
"The government says that it wants to balance the needs of patients in pain with the need to keep addicts from abusing
medication, but that's not what's being accomplished," Reynolds said. "The only people being kept from using drugs in our
society are those legally entitled to use them, our sick people."
Controversial Relationship
Hassman first learned that her opioid prescribing was under review from the Arizona Medical Board, which licenses doctors.
She later found out that the board had received a complaint from an insurance company about her prescribing, she said, and
the board set up a routine and supposedly confidential meeting to discuss it.
Although the right to practice medicine is regulated by state boards, the right to prescribe controlled narcotics is
regulated by the DEA, and the parties share similar concerns, and sometimes information. In Hassman's case, that working relationship
became controversial.
According to an affidavit by Barry Cassidy, executive director of the Arizona board, Hassman was told that her conversation
was being tape-recorded. She was not told, however, that DEA agents were watching the conversation on closed-circuit television
and participating in the interview "by surreptitious means." She learned about the DEA role a year later, during discovery
proceedings for her criminal case.
Cassidy said he did not know about the DEA role and would never have approved it because board conversations are supposed
to be confidential. But Dale Austin, senior vice president of the Federation of State Medical Boards, said it is quite common
for state boards and the DEA to work together, although the degree of collaboration differs from state to state.
Hassman's attorney, Bates Butler, said the DEA-medical board connection was also at work when the Arizona board began
collecting the opioid prescribing records of two Tucson doctors who defended Hassman at a news conference. One of them, Susan
Fleming, said she believes the timing of the review was "no coincidence" and said, "I'm very concerned that one or another
of us will become the next target."
Joan Lewis, a pain specialist in Albuquerque, also ran into trouble with her state medical board after it received complaints
from insurance companies and emergency room doctors about her opioid prescribing. Although she helped write the New Mexico
medical board regulations for prescription opioid use, she was brought before the state board in 2000 and accused of "injudicious
prescribing."
She said she was worried but also angry, because she had for several years been doing elaborate research on how her patients
responded to opioids and other drugs, including one paper published in the American Journal of Pain Management.
Faced with the possible loss of her license to practice, Lewis settled with the New Mexico Board of Medical Examiners
and agreed to a pain management "mini-residency" in Tennessee, which she had to organize herself, and submitted to two years
of monitoring by a board-approved doctor. Lewis also agreed to significantly limit the strength of the opioids she prescribes,
although she said many patients improved only with much higher dosages.
The whole episode, she said, cost her at least $50,000. Although she learned some useful things about opioid use, Lewis
said, the clearest message has been that she needs to protect herself better with extensive documentation and that "it's just
not very safe for doctors to treat pain."
TREATING COCAINE ADDICTION HealthNewsDigest.com - December 23, 2003
UCLA Study Finds Baclofen Holds Promise as First Medication For Treating Cocaine Addiction
(HealthNewsDigest.com)...The anti-spasticity medication baclofen holds promise for helping cocaine abusers overcome
their addiction, a study by a UCLA Neuropsychiatric Institute researcher finds. No medication currently holds U.S. Food
and Drug Administration approval for treatment of cocaine addiction.
Published in the Dec. 15 edition of the peer-reviewed Journal of Clinical Psychiatry, the randomized, double-blind
study found that baclofen used in conjunction with substance abuse counseling significantly reduced cocaine use in recovering
addicts compared to placebo coupled with counseling. The study was funded by the National Institute on Drug Abuse as
part of a project to screen medications with potential for treating cocaine dependence.
"The research shows for the first time, using scientifically rigorous methods, that Baclofen can help people reduce
their cocaine use when they are in drug abuse counseling," said Steven Shoptaw, the study's principal investigator and
a clinical psychologist at the UCLA Neuropsychiatric Institute. "Our findings give us a strong starting place to conduct
more definite studies on whether this medication can help cocaine addicts when used outside controlled research clinics. This
offers new hope to hundreds of thousands of cocaine abusers who struggle with addiction."
According to the federal Substance Abuse and Mental Health Services Administration, cocaine addiction affects 1.7
million American adults. In Los Angeles County, cocaine abuse ranks second only to alcohol as the most frequent cause
for substance abuse treatment.
Baclofen has been approved and prescribed for years to treat spasticity, particularly in muscular sclerosis patients.
Major side effects include fatigue and headache. Baclofen may help cocaine addicts by inhibiting the release of the
neurotransmitter dopamine in the brain, undercutting the "high" caused by cocaine.
The study involved 70 outpatients who underwent a 16-week cocaine addiction treatment program. Half the participants
received baclofen and counseling and half received a placebo, or sugar pill, and counseling. Cocaine use by the patients
was monitored using three urine tests each week throughout the study.
The researchers found that the baclofen group, compared to the placebo group, overall had significantly fewer urine
samples that indicated recent cocaine use, particularly for those participants who started the study with chronic, heavy
rates of crack cocaine use.
The National Institute on Drug Abuse has funded studies evaluating 60 medications for cocaine addiction. Baclofen
is the third medication that has been recommended for a large, multicenter study. An eight-site replication study with
larger patient populations led by Shoptaw at UCLA and funded by the institute is scheduled to begin in February 2004.
Shoptaw conducts his research as part of the UCLA Integrated Substance Abuse Programs, a unit of the UCLA Neuropsychiatric
Institute, and as a principal investigator with Friends Research Institute.
The UCLA Neuropsychiatric Institute is an interdisciplinary research and education institute devoted to the understanding
of complex human behavior, including the genetic, biological, behavioral and sociocultural underpinnings of normal behavior,
and the causes and consequences of neuropsychiatric disorders.
DRUG USE BY TEENAGERS DECLINES, CONTINUES ITS DECLINE Associated Press - December 20, 2003 WASHINGTON (AP)
- American teenagers are cutting back on their use of illicit drugs and cigarettes, but alcohol consumption is holding steady,
the government says.
An annual survey of eighth-, 10th- and 12th-graders done for the Department of Health and Human Services, found declines
in many kinds of drugs for high school students, especially for Ecstasy and LSD.
Overall, the Bush administration said the annual survey funded by the National Institute on Drug Abuse showed an 11
percent drop in illegal drug use in the past two years, slightly surpassing President Bush's goal of a 10 percent reduction
during that period.
The survey, known as Monitoring the Future, tracked drug use and attitudes among 48,500 students from 392 schools.
There was one troubling sign: slowing declines in the use of certain drugs by eighth graders - and a slight increase
in their use of inhalants, said Lloyd D. Johnston, who directed the study by the University of Michigan's Institute
for Social Research.
``We should take this as a little warning because eighth graders have been indicative of things to come in the past,''
Johnston said.
In addition, there was an overall increase in the illicit use of the synthetic painkillers OxyContin and vicodin,
reflective of patterns seen in the general population.
The survey showed a different picture of drug use from another poll of teens that also is used to measure the effectiveness
of White House drug control policy. A private study by Pride Surveys in September showed illegal drug use and cigarette
smoking among sixth- through 12th-graders increased slightly during the last school year compared with the year before.
But both surveys agreed that marijuana remains by far the most widely used illegal drug. Monitoring the Future reported
that it had been tried at least once by 46 percent of 12th graders and used by more than a third in the past year. Both
numbers showed a decrease over last year.
``More kids are seeking treatment for marijuana dependency than all other drugs combined,'' John Walters, director
of the White House Office of National Drug Control Policy, said at a news conference. Walters added that in 15 cities,
surveys have found that more teens smoke marijuana than regular cigarettes.
However, he said the results were encouraging.
``This survey shows that when we push back against the drug problem, it gets smaller,'' Walters said.
Johnston and administration officials offered differing explanations for the decline in use of Ecstasy and LSD.
Ecstasy, also known as MDMA, is a synthetic drug considered part hallucinogen and part amphetamine. The drug became
popular at dance parties because of the energy and euphoria it gave to users, but it has harmful side effects. It can
lead to brain, heart and kidney damage.
Johnston said teens now are more aware about the risks of Ecstasy.
The reduced availability of LSD, following the breakup in 2000 of a lab that produced large quantities of the drug,
accounted for the drop in its use, said Karen Tandy, administrator of the drug enforcement administration. The use of
LSD is at its lowest level since the federal government began a survey of teen-age drug use 30 years ago.
LSD, known as acid, can cause hallucinations and delusions.
The percentage of teens who smoke cigarettes has fallen dramatically from the mid-1990s, the result of advertising
campaigns and the rise in cigarette prices.
But the survey showed that, among 8th- and 10th-graders, the decline slowed significantly.
William V. Corr, executive director of Campaign for Tobacco-Free Kids, said the numbers reflect a ``lack of federal
leadership on tobacco prevention'' and decisions by cash-strapped states to cut their prevention program.
Johnston, the study's director, said that despite progress in keeping teens from smoking, ``one-quarter of our kids,
by the end of high school, are smoking cigarettes.''
On the Net:
Killings by the mentally disturbed 'increasing' By John Steele (Filed: 01/12/2003)
Killings by mentally-disturbed people living in the community in London, and immersed in "chaotic" lives of drink
and drugs, are rising yet many could be prevented, one of Britain's leading police officers said yesterday.
Tarique Ghaffur, the Metropolitan Police assistant commissioner in charge of murder squads, said suspects frequently
had a history of medical treatment but the current system for monitoring them outside hospitals needed "urgent" overhaul.
Police and other agencies dealt well with the small "top tier" of the most dangerous individuals, such as convicted
murderers released from jail or hospitals. But police, doctors, psychiatrists and others all shared some responsibility
for failing to tackle the "middle tier" - a far larger number - of disturbed, potentially violent individuals. Without
strict supervision of medication and drug and alcohol abuse, many deteriorated and the "smallest trigger" could provoke
violence.
Mr Ghaffur said: "It is not my job to criticise the shutting down of hospitals. But the issue it raises is the sheer
number of care-in-the-community institutions and hostels in amongst the communities of London.
"In the investigation into the murder of Margaret Muller, an American artist [in Victoria Park, Hackney], we have
been staggered by the sheer number of institutions in a couple of square miles."
At least 30 hostels, with hundreds of ill people, some potentially dangerous, were identified near the park. In 2002,
the Met concluded there was clear evidence of mental illness in seven murders and suspected it contributed to a number
of others.
This year, officers have established clear evidence in 10 cases, but concede that mental illness probably contributed
to other killings.
Mr Ghaffur made his comments days after Tony Hardy, the "Camden Ripper", was jailed at the Old Bailey for three murders
of women.
The Met, Mr Ghaffur said, had not been aware that Hardy, 53, had been discharged from a sectioning order under the
Mental Health Act, which kept him in hospital for much of 2001 and 2002, was living unsupervised - and slipping back into
alcohol abuse - in Camden. He killed two women after his release.
Tue, Dec. 02, 2003 PAINKILLER ADDICTS GETTING CREATIVE For example, drug abusers are posing as potential homebuyers
to get inside homes -- and steal prescription drugs from medicine cabinets.
BY DONNA LEINWAND USA Today
For real estate agents in Simsbury, Conn., James Dimeola seemed to be the ultimate window shopper. He kept showing
up at open houses last year for homes of wildly varying prices. Sometimes he brought a woman and a child. He would tour
homes thoroughly but would never make an offer.
Then several home sellers complained that some of their prescription drugs were missing from their medicine cabinets.
An office manager for a local real estate office called police, who eventually focused on Dimeola as a suspect. Dimeola,
who later acknowledged being addicted to painkillers, was convicted in January of larceny and is on two years' probation.
The case reflected the increasingly creative tactics that some desperate addicts are using to worm their way into
homes so they can steal prescription painkillers, particularly OxyContin and Percocet. Police across the nation say
that in recent months, drug thieves have posed as potential homebuyers, garage-sale browsers, building inspectors and
police to get into homes -- and then into medicine cabinets.
Authorities in several cities also have reported burglaries by addicts who scanned newspaper obituaries for people
who died of cancer or other painful illnesses. While the deceased person's family members attended the funeral, the
addicts broke into the family's home to look for leftover painkillers.
"Those who are seeking drugs have raised their game to a new level," said Scott Burns of the White House Office for
National Drug Control Policy. "They will use any ruse to get into someone's home --'Can I use your bathroom? Can I use
your phone?' -- and then they clean out the medicine cabinet and are gone before you know it."
Such incidents come at a time when the illicit use of prescription painkillers is becoming more common. The 2002 National
Survey on Drug Use and Health found that 6.2 million people, 3 percent of the U.S. population, abuse prescription drugs
such as OxyContin, an addictive opium derivative.
Reports of addicts targeting open houses have led real estate groups to post alerts in trade magazines and on listing
services. The alerts tell agents to have clients lock up medicines and other valuables before open houses.
Thieves often work in pairs. One might talk with a real estate agent in one room while the other rummages through
cabinets and drawers, said Pili Meyer, a former member of a state safety panel for real estate agents. She encourages
agents to work in pairs so they do not lose sight of a client.
Sometimes, the thieves are legitimate city workers.
Two years ago in Utah, a city building inspector stole medicines while pretending to inspect homes, Burns said. The
inspector hit about 20 houses before he was caught.
"Anyone who has prescription drugs in their home is a potential victim," Burns said. "People are out to get your drugs
any way they can."
MURDERERS LEARN NON-CRIMINAL THINKING SYDNEY (Reuters) - Some of Australia's most violent criminals, including
murderers, are to be taught "non-criminal thinking" in an attempt to subdue their violent behavior.
Up to 70 hardened criminals in jails in the state of New South Wales (NSW) will participate in the nine-month program
involving psychologists, alcohol and drug workers, educators and prison staff, said NSW Justice Minister John Hatzistergos.
"If this program can stop violent behavior in a significant number of inmates, then both correctional officers and
the community will be safer," Hatzistergos said in a statement received Tuesday.
"Reducing the incidence of violence in custody may also reduce re-offending in the community," he said.
The NSW Serious Offenders Review Council will recommend which of the state's most violent prisoners will take part
in the course at Sydney's maximum security Long Bay jail.
The course involves criminals admitting to their violent behavior and taking responsibility for it, learning anger
management and non-criminal thinking, empathizing with victims, and learning to break their lifestyle cycle of crime.
But in case the program doesn't work, there's a back-up.
To ensure the safety of psychologists teaching the criminals, cameras will monitor lessons and staff will have duress
alarms, mobile radios and emergency exits and Long Bay prison's riot squad will also be on standby
Jeffron Boynes Research Editor University of Illinois at Chicago (312) 413-8702; jboynes@uic.eduResearchers at the University of Illinois at Chicago's Jane Addams College of Social Work will use a $1.9 million grant
to study the impact of drugs and the justice system on women and their children.
The grant, from the National Institute on Drug Abuse, will support a five-year pilot project of research and teaching.
"Women who have families are being locked up or losing custody of their children, and the social costs have yet to
be calculated," said Larry Bennett, the study's principal investigator. "We want to look at the effects, not only of
drugs, but of the criminal justice response to drugs, and what that means for children and families of women."
Statistics show that: * Nearly 80 percent of female prisoners in the United States have a history of drug abuse *
Two-thirds of incarcerated women in the U.S. have dependent children * One in every 129 adult women is on probation or
parole
(Source Greenfeld & Snell, 1999, "Women Offenders")
During the project, UIC faculty will work with senior substance-abuse researchers. They envision building a substance-abuse
research program centered at the Jane Addams college.
Headed by Bennett, the researchers will conduct three pilot studies to determine what will help women successfully
leave prison, avoid returning to prison or drugs, and take care of their children once they're released.
The first study will investigate the impact of social services on substance-abusing mothers who have lost custody
of their children. The second study will examine the social service, employment, housing and drug treatment needs of
female ex-inmates in North Lawndale -- a neighborhood with a large number of female ex-offenders. The third study will
look at the influence of HIV on caregivers of children whose mothers have a history of substance abuse and are currently
in the criminal justice system.
Called the Jane Addams Substance Abuse Research Collaboration, the project will build on the college's tradition of
academic and community collaboration, says Bennett, a social work professor. It's a joint effort involving the college
and researchers in other UIC units, including the School of Public Health and departments of criminal justice, psychiatry,
urban planning and public administration.
UIC will also work with Loyola University's criminal justice department and with a number of social service agencies,
including TASC (Treatment Alternatives for Safe Communities).
The grant will pay for a minority research fellowship, an advisory board of senior research associates, and for substance-abuse
research seminars and conferences. UIC is one of six social work programs nationwide picked to receive the grant.
In addition to its substance-abuse research, the Jane Addams College of Social Work serves as home to the Great Lakes
Addiction Technology Transfer Center; the Midwest AIDS Training and Education Center; the Midwest Latino Health, Research,
Training, and Policy Center; the Kinship Care Practice Project; and the Jane Addams Center for Social Policy and Research.
GROUPS WORKING TO REHABILITATE HOMELESS VETERANS Vets are more likely than average to be homeless. Published
November 09. 2003 8:30AM BY KEN KUSMER ASSOCIATED PRESS WRITER INDIANAPOLIS - Darryl Boyd exudes strength from the shaved
head crowning his 6-foot-5, 235-pound Navy veteran's body to his T-shirt's image of bulging biceps pulling a forearm
free of shackles.
But look more closely, and you see the shirt's message: "Freedom from Active Addiction." Listen more closely, and
Boyd speaks of a life filled with weakness: homelessness, alcoholism, crack addiction, mental illness, rejection by
his family.
"Every time I'd get a fleeting glimpse of reality, it was depressing," Boyd said.
Many of the estimated 500,000 homeless among the nation's 27 million veterans share parts of that reality. More than
two-thirds of homeless veterans battle drug and alcohol problems, according to the Department of Veterans Affairs, and
nearly half contend with mental illness.
This year, they are mustering to win more respect from Washington and the public at large. A federal panel on homeless
veterans presented its first recommendations in July, urging more mental health funding and improved service by the
Department of Veterans Affairs.
Veterans groups also are urging more help for former military personnel now out on the streets. Among their leaders
is Chuck Haenlein, a retired career Army officer and president of the board of the National Coalition of Homeless Veterans.
Haenlein also is president of the private, not-for-profit Hoosier Veterans Assistance Foundation, which houses 127
homeless vets in houses, apartments and a detoxification center in Indianapolis. Its annual budget is less than $1 million,
including 30 percent from federal grants.
In June, the foundation created a new program allowing 40 veterans to stay in four- to eight-bedroom houses as long
as needed while they attend a rigorous substance abuse counseling program and receive medical care, if necessary, at
the nearby Roudebush VA Medical Center.
Drug or alcohol abuse in a homeless shelter typically means eviction back to the streets. But the new program
takes a different approach. It requires drug tests, but backsliders get sent down the street to a 50-bed treatment facility.
They receive the second chances they need.
"There's a lot of baby steps, and sometimes a few steps backward," Haenlein said.
Groups like Haenlein's are sprinkled across the country, in many cases working with local VA hospitals to provide
a continuum of care that includes medical wards, detoxification centers, transitional housing and job training. The
VA in August awarded up to $8 million in per-diem payments to 44 programs in 25 states.
Veterans are not immune from the conditions that lead to homelessness, including joblessness, a shortage of affordable
housing and a shrinking public safety net. Many homeless vets no longer trust the government, not even the VA, said
Ron Conley, immediate past national commander of the American Legion.
"The country as a whole turned their back on them . . . so they've kind of dropped out of society, a large part of
them," Conley said.
Surveys show that veterans overall tend to have higher incomes, better educations and lower poverty and unemployment
rates than the general population, but they also have a higher rate of homelessness, the VA says. It estimates that
about a third of homeless adults are veterans, mostly men.
"It's not just homelessness itself. It's alcoholism. It's drug addiction. It's mental health," said Bob Rogers, a
VA social worker who helps mentally ill homeless vets get subsidized housing and clinical help.
Congress passed the Homeless Veterans Comprehensive Assistance Act in December 2001. It required the VA to provide
more help for homeless vets and those at risk of becoming homeless, and to speed up their benefits claims. The law also
prompted the creation of a 17-member VA Advisory Committee on Homeless Veterans.
The panel presented its first annual report in July, delivering recommendations in 30 areas. They include increasing
to $100 million the total amount the VA delivers to local agencies serving homeless vets (the statutory limit now is
$75 million) and working with the Defense Department to counsel servicemen and servicewomen at risk of homelessness.
Veterans groups also are taking up the issue. The largest, the 2.8 million-member Legion, named a task force in January
to lift the profile of homeless vets and create more programs to serve them. In Pennsylvania, Conley heads a Legion
corporation that houses 20 vets in eight homes. Since 1987, 350 veterans have passed through their doors.
"Whoever thought we'd still be involved in it 15 years later, but here we are," Conley said.
Vietnam vet Michael Williams, 53, drank his way out of a home and onto the streets of Indianapolis eight years ago.
He spent a year sleeping most nights under bridges. A fellow ex-Marine found him half-drunk outside a mission and took
him to a Salvation Army detox center. He cleaned himself up and began a series of jobs serving those he left behind
on the streets.
Williams joined Hoosier Vets last year and now treks to missions and his old haunts, persuading homeless vets to re-enter
society.
"When you're in that kind of insanity, you can't even see the light at the end of the tunnel," Williams said.
Boyd has been there. He enlisted in the Navy in 1982, working as a radioman on a submarine tender. After his shipmates
learned he was gay, he tried to take his life with 60 pain pills.
The Navy discharged him in 1986, and Boyd worked as a barber. His mother threw him out when his crack habit nearly
cost her her home. He lived on the streets of Indianapolis for more than a year, working as a prostitute and contracting
HIV. He bounced in and out of rehab programs.
The turning point came last year. He moved into a mission and completed a VA drug rehabilitation program. He found
a job moving skids of textbooks for a college and took real estate classes on the side. The 12-step spirituality of
Narcotics Anonymous resonated within him.
Now he hopes to pass his state realty exam in January and pursue a goal of buying properties to create transitional
housing for homeless veterans.
Said Boyd, confidently pointing to his shaved head, "I've got a plan going on here."
MANY SUBSTANCE ABUSERS 'NOT READY' TO SEEK TREATMENT PR Newswire - November 07, 2003 WASHINGTON, Nov 7, 2003 /PRNewswire
via COMTEX/ -- A new report from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) shows
that even when people recognize they are having problems with alcohol or drugs many do not seek treatment because they are
"just not ready" to stop using. The report also found that many people do not believe they can afford to obtain treatment.
The report estimates there were about 6 million persons with illicit drug dependence or abuse in 2002 that did not
seek specialty treatment for their illicit drug use. There were an estimated 17 million persons in 2002 with alcohol
dependence or abuse who did not receive specialty treatment.
Only 6 percent of those with untreated illicit drug problems, and 4.5 percent of those with untreated alcohol problems,
perceived that they had a need for treatment.
The report was released today by SAMHSA Administrator, Charles G. Curie at a Johnson Institute National Forum on Substance
Abuse in Washington, D.C. The data show among the 362,000 untreated persons who recognize that they are in need of treatment
for their drug problems, 39 percent indicated that they were not ready to stop using illicit drugs and 37 percent perceived
the cost of obtaining treatment as too high.
For the 761,000 untreated persons who recognized in the past year that they needed treatment for alcohol problems,
49 percent indicated they were not ready to stop their alcohol use and 40 percent said that the cost of treatment contributed
to their not receiving treatment.
"It is tragic that a major reason people continue to abuse illicit drugs and alcohol is that they do not believe they
can afford appropriate treatment," Curie said. "President Bush has proposed a three year 'Access to Recovery' program
to provide $200 million more each year for substance abuse treatment. This program would provide someone in need of
substance abuse treatment with a voucher to pay for the services. We really need this program if we are to provide treatment
to the large numbers who say they cannot afford it."
The report, "Reasons for Not Receiving Substance Abuse Treatment" was developed from SAMHSA's National Survey on Drug
Use and Health. The survey was based on interviews with 68,126 respondents who were interviewed in their homes. The
new report is available online at DrugAbuseStatistics.samhsa.gov.
SAMHSA is a public health agency within the U.S. Department of Health and Human Services. The agency is responsible
for improving the accountability, capacity and effectiveness of the nation's substance abuse prevention, addictions
treatment and mental health service delivery systems.
SOURCE Substance Abuse and Mental Health Services Administration
CONTACT: Substance Abuse and Mental Health Services Administration Press
University of Washington Lessons from lives of 37 Texas murderers show different paths to death row Murder
often begins at a terrifyingly young age. It is an awful journey - frequently launched by physical and sexual violence, bullying
and neglect -that terminated in 1997 with the execution of 37 men convicted of murder in Texas.
This road to perdition has been chronicled in a new study exploring the lifelong personal and environmental events
and risk factors these men faced. The study, published in the journal Violence and Victims, compares the lives of men
convicted of committing heinous and less- heinous murders.
The two categories were based on the severity of violence. The heinous murders were marked by extreme rage and brutality,
use of multiple weapons and a seeming lack of remorse, according to lead author Dorothy Van Soest, dean of the School
of Social Work at the University of Washington. For example, one man in this group shot, stabbed and strangled his victim.
Another stabbed his victim 50 times. A third man killed someone, stuffed the body in the trunk of his car, talked casually
to a police officer and then went to a party.
The less-heinous murders tended to be committed during the course of a robbery or by men who were strung out on drugs
and were stopped by the police. Their criminal histories were largely marked by property crimes.
"We need to understand violence better. That does not mean condoning violence," said Van Soest. "However, we need
to switch the focus from punishment to prevention. We need to look at what causes violence so we can understand the
paths leading to extreme violence." Van Soest began the research while she was a University of Texas at Austin social
work professor and associate dean. She decided to focus on Texas because that state has the highest rate of executions
in the United States since the death penalty was reinstated in the late 1970s. Texas has accounted for more than one-third
of all executions, and in 1997 the 37 men represented half of the people put to death in the United States.
Of the 37 men in this study, 22 were white, 13 were black and two were Latino. Among the whites, 16 of the crimes
were evaluated as heinous and six as less heinous. There were six heinous and seven less heinous among the blacks while
the two Latino murders were split between the two categories.
A goal of the research, Van Soest said, was to examine the multiple constellations of risk factors and see how they
may have influenced the lives of men who were executed. To do this, she and her colleagues reviewed all available documents
and reports on the men. These included reports and testimony given at their trials, appeal documents and data from their
psychological, neurological, medical, social service, welfare, school, probation, and military records. In addition,
the researchers examined prison packets kept by the Texas Department of Criminal Justice, which contained their social
and criminal histories and an FBI report on their criminal histories. Despite all of these sources, many of the records
were incomplete or superficial, she said, and the researchers could not determine whether some of the risks were present
in an individual's life.
The most striking factor that springs from the study is the prevalence of childhood violence in the lives of many
of these men. Of the 20 men for whom there is evidence of childhood physical abuse, 15 later were convicted of committing
heinous murders. Five of the men in the less-heinous category also were victims of childhood physical abuse. In addition,
virtually all those whose childhood backgrounds included sexual abuse, physical abuse and physical or emotional neglect
were convicted of committing the most-heinous crimes.
The men in the heinous category were more likely to be white, poor and to have gotten involved with alcohol and drugs
at an early age. The mean starting age for alcohol was 12.6 years and it was 13.7 years for other drugs. In addition,
10 of the 12 men who perpetrated sexual abuse were from the heinous group. These men also were more likely to suffer
from hallucinations and some form of brain dysfunction.
"There is some evidence that when these men were boys they tried to be good, and later retreated to alcohol and drugs
at an early age. They were terribly abused and were just trying to survive. Some of the cases were heartbreaking, but
they turned out to behave as if they were monsters rather than hurt human beings," said Van Soest.
Men in the less-heinous group were more likely to have bullied their peers and had profiles that included being black,
having problems in school, dropping out of high school and having a juvenile crime record.
"When people looked at these individuals they would tend to say, 'These kids are trouble,'" said Van Soest. "Another
thing that this study shows is that black men were executed by Texas for less- heinous crimes than those committed by
whites, which is consistent with how the death penalty has been applied in this country."
She added that one of the damning findings of the study was a seeming invisibility of early community intervention
when these men were young.
"Society seemed to have two approaches in relation to the men in the study and both were damaging," Van Soest said.
" The most heinous, as boys, withdrew and self-medicated their pain. The less heinous received ineffective or no intervention
as children, and I suspect that they became criminalized as they entered the justice system.
"We have hints, not answers, from this study about what went on in the lives of these men. For example, most people
who are victims of abuse do not commit violence, but those in the most-heinous group were all child victims of violence.
We need to further look at the multiple constellations of risk factors and how they work together. We also need to educate
people who work with children about what those factors are and counter them with protective ones." ###
Co-authors of the study are Toni Johnson and Beverly McPhail, both of whom are expected to receive their doctorates
in social work later this month from the University of Texas at Austin, and Hyun-Sun Park, a University of Texas at
Austin doctoral student in social work.
HealthNewsDigest.com - November 03, 2003 POTENTIAL TO HELP HIGH-RISK CHILDREN AND FAMILIES FOCUS OF STUDY BUFFALO,
N.Y. -- (HealthNewsDigest.com)...Children raised by substance-abusing parents often manifest substantial emotional, behavioral
and social problems. Despite this, most parents who enter treatment for substance abuse are very reluctant to allow their children
to be involved in treatment or therapy.
To address the problem, researchers at the University at Buffalo's Research Institute on Addictions (RIA) are developing
a hybrid treatment method that incorporates training for parents, couples therapy and reduction of substance abuse.
The project is being funded by a $2.8 million grant from the National Institute on Drug Abuse to William Fals-Stewart,
Ph.D., a senior research scientist at RIA and a research associate professor in the Department of Psychology, UB College
of Arts and Sciences.
Fals-Stewart said that 216 married or co-habiting couples, comprised of substance-abusing fathers and nonsubstance-abusing
mothers with one or more children, ages 0-12 years, will be recruited for the study. The men will be entering outpatient
treatment at community agencies for help with their drug problem.
"We've just finished a study that showed when couples participate in behavioral couples therapy (BCT), their young
children display higher psychosocial adjustment in the year after the parents' treatment," Fals-Stewart said, "than
children whose parents received other forms of intervention."
The positive effects of couple's treatment -- including reduced substance use, improved communication and reduced
partner violence -- appear to lead to improvement in the children's behavior or functioning.
According to Fals-Stewart, "Our findings suggest that BCT has significant effects on the family that extend beyond
the couple to their children, even though the children were not actively involved in treatment. In the previous study,
parent skills training was not a part of the treatment and parenting issues were not even discussed. We're very hopeful
that by including this element, an even stronger statement can be made for a new treatment method."
Secretary of Health and Human Services Tommy Thompson recently called for substance-abuse treatment programs to recognize
and deal with the emotional and behavioral problems of children whose parents seek help for alcoholism or drug abuse.
He stated, "We must not allow our children to become the forgotten victims of substance abuse.
By providing appropriate services and programs, we have the power to reduce the fear and confusion that they experience
and to provide theknowledge and skills that they need to rebound and succeed as they mature into adults."
Intervention programs traditionally face barriers to involving children: approximately two-thirds of fathers seeking
substance-abuse treatment and almost half of mothers seeking treatment indicate they are unwilling to have their children
participate in individual- or family-based treatment. Some parents may have legal or social service issues, others may
not want family issues aired in front of strangers.
In other cases and depending on their age, children may refuse to participate, providers may not be prepared to deal
with child-related issues, evening hours for family appointments can be limited or unavailable and billing for these
services can be problematic for agencies with funding concerns.
Fals-Stewart's approach would allow child-related issues to be addressed in treatment, without requiring the presence
of the child.
As a new treatment targeted at substance-abusing patients and their children, this intervention has the potential
for broad and prolonged effects that extend beyond the patients seeking treatment for substance abuse to the children
under their care. Such interventions represent an attempt to address a chronic public-health concern. The intervention
may prove effective with parents, their high-risk children as they enter adolescence and early adulthood, their children's
children and society in general.
The UB investigation is just one step toward long-term clinical study into children's adjustment, fathers' substance
use, and family and relationship functioning. Study of provider concerns such as extensive cost, cost-benefit and cost-effectiveness
comparisons also will be conducted.
Neil B. McGillicuddy, Ph.D., co-investigator on the research team, is a senior research scientist at RIA and an expert
in parental training for families with adolescent substance abusers, interventions for adolescent drug abusers and treatment
for partners of addicted persons.
Other co-investigators include Francis D. Fincham, Ph.D., SUNY
Distinguished Professor in the Department of Psychology, UB College of Arts and Sciences; Brian Yates of American
University in Washington, D.C., and Michelle Kelley of Old Dominion University in Norfolk, Va.
Scientists at UB's Research Institute on Addictions have been advancing the knowledge, prevention, and treatment of
addictions since 1970. (c) Health News Digest.com 2003 All Rights Reserved.
Study Finds Hundreds of Thousands of Inmates Mentally Ill October 22, 2003 By FOX BUTTERFIELD - - NY Times
As many as one in five of the 2.1 million Americans in jail and prison are seriously mentally ill, far outnumbering
the number of mentally ill who are in mental hospitals, according to a comprehensive study released Tuesday.
The study, by Human Rights Watch, concludes that jails and prisons have become the nation's default mental health system,
as more state hospitals have closed and as the country's prison system has quadrupled over the past 30 years. There
are now fewer than 80,000 people in mental hospitals, and the number is continuing to fall.
The report also found that the level of illness among the mentally ill being admitted to jail and prison has been growing
more severe in the past few years. And it suggests that the percentage of female inmates who are mentally ill is considerably
higher than that of male inmates.
"I think elected officials have been all too willing to let the incarcerated population grow by leaps and bounds without
paying much attention to who in fact is being incarcerated," said Jamie Fellner, an author of the report and director
of United States programs at Human Rights Watch.
But, Ms. Fellner said, she found "enormous, unusual agreement among police, prison officials, judges, prosecutors
and human rights lawyers that something has gone painfully awry with the criminal justice system" as jails and prisons
have turned into de facto mental health hospitals. "This is not something that any of them wanted."
Reginald Wilkinson, director of the Ohio Department of Rehabilitation and Correction, said the "mere fact that this
report exists is significant."
"Some people won't like it, and the picture it paints isn't pretty," Mr. Wilkinson said. "But getting these facts
out there is progress."
Many of the statistics in the study have been published before by the Justice Department, the American Psychiatric Association
or states. But the study brings them together and adds accounts of the experiences of dozens of people with mental illness
who have been incarcerated.
The study found that prison compounds the problems of the mentally ill, who may have trouble following the everyday discipline
of prison life, like standing in line for a meal.
"Some exhibit their illness through disruptive behavior, belligerence, aggression and violence," the report found. "Many
will simply - sometimes without warning - refuse to follow straightforward routine orders."
Where statistics are available, mentally ill inmates have higher than average disciplinary rates, the study found.
A study in Washington found that while mentally ill inmates constituted 18.7 of the state's prison population, they accounted
for 41 percent of infractions.
This leads to a further problem - mentally ill inmates who cannot control their behavior are often, and disproportionately,
placed in solitary confinement, the study found.
Solitary confinement is particularly difficult for mentally ill inmates because there is even more limited medical
care there, and the isolation and idleness can be psychologically destructive, the report says.
Medical care for mentally ill inmates is often almost nonexistent, the study says. In Wyoming, a Justice Department
investigation found that the state penitentiary had a psychiatrist on duty two days a month. In Iowa, there are three
psychiatrists for more than 8,000 inmates.
There is no single accepted national estimate of the number of mentally ill inmates, in part because different states use
different ways to measure mental illness.
The American Psychiatric Association estimated in 2000 that one in five prisoners were seriously mentally ill, with
up to 5 percent actively psychotic at any given moment.
In 1999, the statistical arm of the Justice Department estimated that 16 percent of state and federal prisoners and
inmates in jails were suffering from mental illness. These illnesses included schizophrenia, manic depression (or bipolar
disorder) and major depression.
The figures are higher for female inmates, the report says. The Justice Department study found that 29 percent of
white female inmates, 22 percent of Hispanic female inmates and 20 percent of black female inmates were identified as mentally
ill.
One reason some experts have suggested for the higher numbers among female prisoners is that psychologists and psychiatrists
working in prisons tend to be more sympathetic to women, finding them mentally ill, while they tend to evaluate male
inmates as antisocial or bad.
But Mr. Wilkinson said, "I think the differences are real; more female inmates are mentally ill." He suggested that prisons
were seeing more severely mentally ill inmates now "only because the volume is greater," meaning that the number of
people in prison has increased.
Mon Oct 13 09:02:09 2003 Pacific Time SPERM FROM MARIJUANA SMOKERS MOVE TOO FAST, TOO EARLY, IMPAIRING FERTILITY,
UNIVERSITY AT BUFFALO RESEARCH SHOWS BUFFALO, N.Y., Oct. 13 (AScribe Newswire) -- Men who smoke marijuana frequently
have significantly less seminal fluid, a lower total sperm count and their sperm behave abnormally, all of which may affect
fertility adversely, a new study in reproductive physiology at the University at Buffalo has shown.
This study is the first to assess marijuana's effects on specific swimming behavior of sperm from marijuana smokers
and to compare the results with sperm from men with confirmed fertility. Marijuana contains the cannabinoid drug THC
(tetrahydrocannabinol), which is its primary psychoactive chemical, as well as other cannabinoids.
Results of the study were presented today (Oct. 13, 2003) at the annual meeting of the American Society of Reproductive
Medicine in San Antonio.
"The bottom line is, the active ingredients in marijuana are doing something to sperm, and the numbers are in the
direction toward infertility," said Lani J. Burkman, Ph.D., lead author on the study. Burkman is assistant professor
of gynecology/obstetrics and urology and head of the Section on Andrology in the UB School of Medicine and Biomedical
Sciences. UB's andrology laboratory also carries out sophisticated diagnosis for infertile couples.
"We don't know exactly what is happening to change sperm functioning," said Burkman, "but we think it is one of two
things: THC may be causing improper timing of sperm function by direct stimulation, or it may be bypassing natural inhibition
mechanisms. Whatever the cause, the sperm are swimming too fast too early." This aberrant pattern has been connected
to infertility in other studies, she noted.
Burkman collaborated on earlier, published UB research that was the first to show that human sperm contains cannabinoid
receptors, and that the naturally occurring cannabinoid, anandamide, which activates cannabinoid receptors in the brain
and other organs, also activates receptors in sperm. This evidence indicated an important role in reproduction for natural
cannabinoids.
Further research in the andrology laboratory showed that human sperm exposed to high levels of THC displayed abnormal
changes in the sperm enzyme cap, called the acrosome. When researchers tested synthetic anandamide equivalents on human
sperm, the normal vigorous swimming patterns were changed and the sperm showed reduced ability to attach to the egg
before fertilization. Only about 10 laboratories in the U.S. perform this array of sperm function tests.
In the current study, Burkman received seminal fluid from 22 confirmed marijuana smokers and subjected the samples
to a variety of tests. The volunteers reported smoking marijuana approximately 14 times a week, and for an average of
5.1 years.
Control numbers were obtained from 59 fertile men who had produced a pregnancy. All men abstained from sexual activity
for two days before the lab analysis.
The samples from both groups were tested for volume, sperm-count-per-unit of seminal fluid, total sperm count, percent
of sperm that was moving, velocity and sperm shape. Sperm also were assessed for an important function called hyperactivation
(HA), a closely regulated and very vigorous type of swimming that is required as the sperm approaches the egg. The researchers
evaluated HA and velocity while the sperm was in seminal fluid and again after washing and incubation, when the dead
sperm were eliminated.
Results showed that both the volume of seminal fluid and the total number of sperm from marijuana smokers were significantly
less than for fertile control men. Significant differences also appeared when HA and velocity, both before and after
washing, were assessed, the study found.
"The sperm from marijuana smokers were moving too fast too early," said Burkman. "The timing was all wrong. These
sperm will experience burnout before they reach the egg and would not be capable of fertilization."
Burkman noted that many men who smoke marijuana have fathered children.
"The men who are most affected likely have naturally occurring borderline fertility potential, and THC from marijuana
may push them over the edge into infertility," she said.
As to the question of whether fertility potential returns when smokers stop using marijuana: Burkman said the issue
hasn't been studied well enough to provide a definitive answer.
"THC remains stored in fat for a long period, so the process may be quite slow. We can't say that everything will
go back to normal. Most men who have borderline fertility are unaware of that fact. It's difficult to know who is at
risk. I definitely would advise anyone trying to conceive not to smoke marijuana, and that would include women as well
as men."
Additional scientists on the study included Herbert Schuel, Ph.D., UB professor of pathology and anatomical sciences,
and the staff of the andrology laboratory.
Survey: 11 million have driven while high Tuesday, September 16, 2003 Posted: 10:14 PM EDT (0214 GMT) < http://www.cnn.com/2003/US/South/09/16/drugged.driving.ap/index.html> WASINGTON (AP) -- An estimated 11 million Americans, including nearly one in five 21-year-olds, have driven while
under the influence of illegal drugs, the government says.
The numbers announced Tuesday were especially high for college students. Eighteen percent of students surveyed said
they drove while on drugs last year, compared with 14 percent of their peers who weren't in college.
John Walters, director of the White House Office of National Drug Control Policy, said the statistics show a failure
to convince drivers that drugs impair driving as much as alcohol does. His office is kicking off an ad campaign to warn
teens about driving while smoking marijuana.
"Marijuana is not the soft drug. Marijuana is not the casual rite of passage," Walters said at a news conference.
"We have been sending the wrong message."
Walters said marijuana can affect concentration, perception, coordination and reaction time for up to 24 hours after
smoking it.
Nineteen-year-old Theodore Stevens of New Jersey told reporters that he believed smoking pot and driving wasn't dangerous
despite getting into four accidents in three years. He says he's lucky none of those incidents caused serious injuries.
"Sometimes I believed it increased my driving performance," said Stevens, who has been in drug treatment for four
months after being charged with possession of marijuana, cocaine and heroin. Stevens began smoking pot when he was 14.
The report, compiled by the U.S. Department of Health and Human Services, used 2002 data from the National Survey
on Drug Use and Health. The survey questioned 68,000 people. Researchers then extrapolated the percentages to the population
as a whole. A federal statistician said the margin of error was plus or minus 4.5 percentage points.
For 21-year-olds, the rate of those who reported driving under the influence of drugs was 18 percent, the highest
of any age group. That dropped off to 14.5 percent for 22-year-olds. Unemployed adults age 26 to 49 also had a high
frequency of driving while drugged -- 9.3 percent, compared with 5.1 percent for drivers employed full time.
Among racial or ethnic groups, American Indians reported the highest rate of driving while drugged, at 6.3 percent
compared with 5 percent of whites, 4.5 percent of blacks, 3.7 percent of Hispanics, 3.1 percent of Pacific Islanders
and 1.3 percent of Asians.
Dr. Jeffrey Runge, head of the National Highway Traffic Safety Administration, said there were approximately 38,000
crashes last year involving drivers impaired by marijuana. But Runge said he didn't know how many fatal accidents were
caused by drugged drivers. State data collection is spotty, Runge said, and many drivers who are driving while drugged
are also drinking.
"While we don't have fixed data, impairment is impairment," he said.
22 MILLION IN U.S. SUFFER FROM SUBSTANCE DEPENDENCE OR ABUSE, SAYS SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES
ADMINISTRATION 9/5/03 10:20:00 AM WASHINGTON, Sept. 5 /U.S. Newswire/ -- In 2002, an estimated 22 million Americans
suffered from substance dependence or abuse due to drugs, alcohol or both, according to the newest results of the Household
Survey released today by the Substance Abuse and Mental Health Services Administration in the Department of Health and
Human Services (HHS). There were 19.5 million Americans, 8.3 percent of the population ages 12 or older, who currently used
illicit drugs, 54 million who participated in binge drinking in the previous 30 days, and 15.9 million who were heavy drinkers.
The report highlights that 7.7 million people, 3.3 percent of the total population ages 12 and older, needed treatment
for a diagnosable drug problem and 18.6 million, 7.9 percent of the population, needed treatment for a serious alcohol
problem. Only 1.4 million received specialized substance abuse treatment for an illicit drug problem and 1.5 million received
treatment for alcohol problems. Over 94 percent of people with substance use disorders who did not receive treatment did
not believe they needed treatment.
There were 362,000 people who recognized they needed treatment for drug abuse. Of them, there were 88,000 who tried
but were unable to obtain treatment for drug abuse in 2002. There were 266,000 who tried, but could not obtain treatment
for alcohol abuse.
"There is no other medical condition for which we would tolerate such huge numbers unable to obtain the treatment
they need," HHS Secretary Tommy G. Thompson said. "We need to enact President Bush's Access to Recovery Program to provide
treatment to those who seek to recover from addiction and move on to a better life. That is what Recovery Month is all
about."
The new 2002 Household Survey has been renamed the National Survey on Drug Use and Health. The survey creates a new
baseline with many improvements. The annual survey of approximately 70,000 people was released as part of the kick-off
for the 14th annual National Drug and Alcohol Addiction Recovery Month (Recovery Month) observance.
John Walters, White House Director of National Drug Control Policy, pointed out that "a denial gap of over 94 percent
is intolerable. People need to understand the addictive nature of drugs and not presume that they are 'all right' when
everyone around them knows better. Families and friends need to urge their loved ones to seek treatment when they experience
the toll that addiction takes on loved ones and communities."
The 2002 survey found that marijuana is the most commonly-used illicit drug, used by 14.6 million Americans. About
one third, 4.8 million, used it on 20 or more days in the past month. There was a decline in the number of adolescents
under age 18 initiating use of marijuana between 2000 and 2001, according to the 2002 survey. There were 1.7 million youthful
new users in 2001, down from 2.1 million in 2000. The percentage of youth ages 12-17 who had ever used marijuana declined
slightly from 2001 to 2002, from 21.9 percent to 20.6 percent. Most youngsters 12-17 reported that the last marijuana
they used was obtained without paying, usually from friends.
"Prevention is the key to stopping another generation from abusing drugs and alcohol," SAMHSA Administrator Charles
G. Curie said. "It is gratifying to see that fewer adolescents under age 18 are using marijuana. Now, we need to step
up our prevention activities to drive the numbers down further."
The survey found that 30 percent of the population 12 and older, 71.5 million people, use tobacco. Most of them smoke
cigarettes. But, the number of new daily smokers decreased from 2.1 million per year in 1998 to 1.4 million in 2001.
Among youth under age 18, the decline was from 1.1 million per year in each year between 1997 and 2000 to 757,000 in 2001.
This is a decrease from about 3,000 new youth smokers per day to 2,000 per day.
In 2002, there were 2 million persons who currently used cocaine, 567,000 of whom used crack. Hallucinogens were used
by 1.2 million people, including 676,000 who used Ecstasy. There were 166,000 current heroin users. Among youngsters
12-17, inhalant use was higher than use of cocaine.
The second most popular category of drug use after marijuana is the non-medical use of prescription drugs. An estimated
6.2 million people, 2.6 percent of the population ages 12 or older, were current users of prescription drugs taken non-medically.
Of these, an estimated 4.4 million used narcotic pain relievers, 1.8 million used anti-anxiety medications (also known
as tranquilizers), 1.2 million used stimulants and 0.4 million used sedatives. The survey estimates that 1.9 million persons
ages 12 or older used OxyContin non- medically at least once in their lifetime.
Current illicit drug use is highest among young adults 18 to 25 years old, with over 20 percent using drugs. Youth
ages 12-17 also are significant users, with 11.6 percent currently using illicit drugs. Among adults ages 26 and older,
5.8 percent reported current drug use. There were also 9.5 million full-time workers, 8.2 percent, who used illicit drugs
in 2002. Of the 16.6 million illicit drug users ages 18 or older in 2002, 12.4 million were employed either full or
part time.
The 2002 survey found that 11 million people, 4.7 percent of the population ages 12 or older, reported driving
under the influence of an illicit drug during the past year. Those age 21 reported the highest rate of driving while
drugged, 18 percent, but the rate was 10 percent or greater for each age from 17 to 25.
About 10.7 million people ages 12 to 20 (28.8 percent of this age group) reported drinking alcohol in the month prior
to the survey interview. Of these, 7.2 million were binge drinkers (19.3 percent) and 2.3 million were heavy drinkers
(6.2 percent). There were 33.5 million Americans who drove under the influence of alcohol at least once in the 12 months
prior to the interview.
Of those 3.5 million people ages 12 or older who received some kind of treatment related to the use of alcohol or
illicit drugs in the 12 months prior to the survey interview, 974,000 received treatment for marijuana, 796,000 received
treatment for cocaine, 360,000 received treatment for non medical use of narcotic pain relievers, 277,000 for heroin, and
2.2 million received treatment for alcohol.
Trends in lifetime use of substances were calculated from the 2002 survey based on reports of prior use. Use of pain
relievers non-medically among those ages 12-17 increased from 9.6 percent in 2001 to 11.2 percent in 2002, continuing
an increasing trend from 1989 when only 1.2 percent had ever used pain relievers non-medically in their lifetime. Among
young adults, ages 18-25, the rate of ever having used pain relievers non-medically increased from 19.4 percent in 2001
to 22.1 percent in 2002. This rate was 6.8 percent in 1992.
For teens ages 12-17, the lifetime LSD rate is down from 3.3 percent of this population to 2.7 percent, the Ecstasy
rate is up slightly from 3.2 percent to 3.3 percent, cocaine use is up from 2.3 percent of this population to 2.7 percent,
and inhalant use is up from 9 percent in 2001 to 10.5 percent in 2002.
In 2002, the survey found, over 83 percent of youth ages 12-17 reported having seen or heard alcohol or drug prevention
messages outside of school in the past year. Youth who had seen or heard these messages indicated a slightly lower past
month use of an illicit drug (11.3 percent) than teens who had not seen or heard these types or messages (13.2 percent).
There are 4 million adults who have both a substance use disorder and serious mental illness. In 2002, there were
an estimated 17.5 million adults ages 18 or older with serious mental illness. This is 8.3 percent of all adults. Adults
who used illicit drugs were more than twice as likely to have serious mental illness as adults who did not use an illicit
drug. Among adults who used an illicit drug in the past year, 17.1 percent had serious mental illness in that year,
compared to 6.9 percent of adults who did not use an illicit drug.
Among adults with serious mental illness in 2002, over 23 percent, were dependent on or abused alcohol or illicit
drugs. The rate among adults without serious mental illness was only 8.2 percent. Among adults with substance dependence
or abuse, 20.4 percent had serious mental illness, compared with 7 percent among adults who were not dependent on or abusing alcohol
or drugs.
The survey is based on interviews with 68,126 respondents who were interviewed in their homes. This includes persons
residing in dormitories or homeless shelters. The interviews represent 98 percent of the population ages 12 and older.
Not included in the survey are persons in the active military, in prisons or other institutionalized populations or who
are homeless.
Recovery Month is a celebration of the accomplishments of people in recovery. Since its inception, it has highlighted
the strides made in substance abuse treatment. This year's theme, "Join the Voices for Recovery: Celebrating Health"
emphasizes that addiction to alcohol and drugs is a chronic, but treatable, public health problem that affects everyone
in the community. Recovery Month is celebrated to promote the message of recovery, applaud the courage of people in
recovery and recognize the contributions of treatment providers. More than 90 organizations and individuals partner with SAMHSA
in the Recovery Month planning process.
HHS agencies -- including SAMHSA, the Centers for Disease Control and Prevention (CDC), the National Institute on
Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) -- play a key role in the administration's
substance abuse strategy, leading the federal government's programs in drug abuse research and funding programs and campaigns
aimed at prevention and treatment, particularly programs designed for youth. An HHS fact sheet with more information is
available at http://www.hhs.gov/news/press/ . Other background and resources are available at the Web sites for SAMHSA ( http://www.samhsa.gov), CDC ( http://www.cdc.gov), NIDA ( http://http://www.nida.nih.gov ) and NIAAA ( http://www.niaaa.nih.gov ).
University of Iowa examines role of faith-based groups in helping ex-offenders Each year, nearly 500,000 people
are released from prison in the United States. Their success at re-entry into society often depends on the support they
receive for addressing problems such as substance abuse, lack of job skills and a fractured personal social network.
In Iowa, where approximately 400 people are released from prison each month, faith-based groups play an informal but
significant role in helping released offenders rebuild their lives. The finding is included in a report by the University
of Iowa Consortium for Substance Abuse Research and Evaluation, which set out to examine the largely undocumented role
these local groups play in Johnson County, Iowa in helping people released from prison.
The report also finds that improved communication with formal rehabilitation services, such as probation programs
and substance abuse groups, could help the faith-based groups be even more effective. In addition, these groups overall
would rather government do more to support existing mandated support programs than provide them grant opportunities
for their efforts.
The study team surveyed 15 faith-based organizations (Christian, Jewish and Muslim) as well as staff with the Sixth
Judicial District Correctional Services (part of the state's Department of Corrections) and staff with the Mid-East
Council on Chemical Abuse. The results are available in a report called "An Environmental Scan of Faith-Based and Community
Reentry Services in Johnson County, Iowa." The report is available online at < http://iconsortium.subst-abuse.uiowa.edu> , by sending an e-mail request to julia-neff@uiowa.edu or by calling 319-335-4488.
"What little work has been done on the role of faith-based organizations has been in very large cities. We wanted
to look at their role in an area like Johnson County which includes a rural population," said Stephan Arndt, Ph.D.,
UI professor of psychiatry and one of the report authors.
The team was not surprised to find that the faith-based groups "do more than they think they do and more than outsiders
think they do," said Arndt, who also is director of the UI Consortium for Substance Abuse Research and Evaluation.
Arndt said that people released from prison are socially disengaged and often estranged from their family, friends
and previous, if any, business associates. Add the fact that many ex-offenders are struggling with substance abuse problems,
and it is clear a person just out of prison could use support.
Faith-based groups help adults make a new start through study and discussion groups, choir, one-on-one spiritual counseling,
and sports and social activities. They also provide practical help such as rental assistance, food and clothing banks,
and transportation.
"People tend to think that all public services have to stem from governmental agencies. In truth, communities have
provided for those in need for a long time. The lack of recognition may be because faith-based and community-based organizations
often do not advertise the massive amounts of service they do," Arndt said.
The surveyors were somewhat surprised to learn that the Iowa Department of Corrections and the substance abuse agencies
do not have much direct communication with the faith-based agencies.
If, on being released, an offender says he wants to go to a church, a correctional staff member's best resource currently
is to provide a phone book. A good resource to develop, Arndt said, would be a directory that lists congregations and
describes the services and atmosphere they provide.
Another way to improve communication is for the formal support providers -- the correctional probation/parole officers
and substance abuse counselors -- to attend church events such as barbeques, where they can learn more about how the
organizations help offenders and understand how referrals to faith-based groups can be made while still respecting separation
of church and state.
The faith-based groups themselves were open to building communication and understanding rather than getting more money.
The consortium found that church and other faith-based groups are wary of accepting government funds to do their work.
"There was the general notion was that more government monies should go to public social services such as help for
the disabled, children, the mentally ill and those with addictions," Arndt said.
Consortium staff also assisting with the report were Janet Hartman, program associate, and Kristina Barber, associate
director.
STORY SOURCE: University of Iowa Health Science Relations, 5137 Westlawn, Iowa City, Iowa 52242-1178
DUTCH APPROVE CANNABIS AS PRESCRIPTION DRUG Mon September 1, 2003 07:20 AM ET By Paul Gallagher AMSTERDAM (Reuters)
- The Netherlands Monday became the world's first country to make cannabis available as a prescription drug in pharmacies
to treat cancer, HIV and multiple sclerosis patients, the Health Ministry said.
The Netherlands is making the drug widely available to chronically ill patients amid pressure on countries like Britain,
Canada, Australia and the United States to relax restrictions on its supply as a medicine.
Dutch doctors will be allowed to prescribe it to treat chronic pain, nausea and loss of appetite in cancer and HIV
patients, to alleviate MS sufferers' spasm pains and reduce physical or verbal tics in people suffering Tourette's syndrome.
"From September 1, 2003 pharmacies can provide medicinal cannabis to patients with a prescription from a doctor. Cannabis
has a beneficial effect for many patients," the Health Ministry said.
The Netherlands, where prostitution and the sale of cannabis in coffee shops are regulated by the government, has
a history of pioneering social reforms. It was also the first country to legalize euthanasia.
Two companies in the Netherlands have been given licenses to grow special strains of cannabis in laboratory-style
conditions to sell to the Health Ministry, which in turn packages and labels the drug in small tubs to supply to pharmacies.
As well as pharmacies, 80 hospitals and 400 doctors will be allowed to dispense five-gram doses of SIMM18 medical
marijuana for 44 euros ($48) a tub and more potent Bedrocan at 50 euros.
The Health Ministry recommends patients dilute the cannabis -- which will be in the form of dried marijuana flowers
from the hemp plant rather than its hashish resin -- in tea or turn it into a spray.
HIV SUFFERERS WELCOME MOVE
A British drug firm pioneering cannabis spray medicine to give pain relief for multiple sclerosis patients is hoping
to launch the product in Britain later this year.
The association of HIV patients in the Netherlands welcomed the government's move to make cannabis available in high-street pharmacies.
"We are glad the government recognizes that for some people it can improve the quality of life," said Robert Witlox,
managing director of HIV Vereniging. The association has called on health insurers to cover the cost of the drug like
any other.
The government, which recognized many chronically ill people were already buying cannabis from coffee shops, said
it should only be prescribed by doctors when conventional treatments had been exhausted or if other drugs had side-effects.
The government said it would start distributing to pharmacies Monday. The Health Ministry's Office of Medicinal Cannabis
has a monopoly on wholesale distribution of the drug, grown in laboratory-style conditions to ensure medicinal purity.
The ministry estimates up to 7,000 people in the Netherlands have used cannabis for medical reasons, buying it in
coffee shops. It said this could more than double once it was available from pharmacies in pure medicinal form.
Cannabis has a long history of medicinal use. It was used as a Chinese herbal remedy around 5,000 years ago, while
Britain's Queen Victoria is said to have taken cannabis tincture for menstrual pains.
But it fell out of favor because of a lack of standardized preparations and the development of more potent synthetic
drugs.
Critics argue that it has not passed sufficient scientific scrutiny at a time when researchers are trying to determine
if it confers the medical benefits many users claim. Some doctors say it increases the risk of depression and schizophrenia.
Reported August 13, 2003 Heroin to Treat Addiction? (Ivanhoe Newswire) -- It may sound crazy, but researchers
say giving heroin to opiate addicts can help them become less dependent on the drug.
Researchers in the Netherlands conducted two separate studies of more than 500 heroin addicts who did not respond
to methadone maintenance treatment. Participants were either injected with or inhaled doses of heroin, depending on
the study in which they were enrolled.
The participants received either 12 months of methadone treatment alone, 12 months of methadone treatment plus heroin,
or six months of methadone treatment alone followed by six months of methadone plus heroin treatment.
Results show adding heroin to methadone is a safe and effective treatment. Researchers say the combination can reduce
the many physical, mental and social problems experienced by heroin addicts. The study shows treatment with heroin plus
methadone is significantly more effective than treatment with methadone alone.
Researchers say few serious side effects occurred during the course of the study. Authors conclude, "Our study provides
strong evidence of the efficacy of prescribed heroin for addicts who are resistant to other forms of treatment."
SOURCE: British Medical Journal , 2003;327:310
THE ROOTS OF ADDICTION Study identifies brain area linked to drug addiction WEDNESDAY, Aug. 13 (HealthDayNews)
-- Specific nerve cells in a brain region called the nucleus accumbens are linked to relapse in recovering drug addicts.
That's what researchers from Rutgers University discovered. Their report appears in the Aug. 13 issue of the Journal
of Neuroscience .
The finding may help researchers develop new addiction therapies and intervention strategies.
Even after addicts have been drug-free for a long time, they're susceptible to relapse when exposed to simple events
or circumstances associated with prior drug use. For example, walking through a particular neighborhood or hearing a
certain song may reawaken memories that trigger a craving and lead to a relapse.
"We've identified a part of the brain that appears to process these memories. This might be one of the brain areas
that a very skilled pharmacological approach could target," researcher and psychology professor Mark West says in a
news release.
He and his colleagues zeroed in on the nerve cells in the nucleus accumbens during experiments with laboratory rats.
The rats were able to self-administer cocaine by pressing a lever. Microelectrodes were used to monitor the activity
of specific nerve cells in a part of the nucleus accumbens known as the shell.
When the rats pressed the lever to receive cocaine, a tone sounded. The rats came to associate the tone with the drug
and by the end of three weeks had learned to press the lever when they heard the tone.
The researchers then removed both the cocaine and lever. After a month, the lever -- but no cocaine -- was returned
to the rats' cage. The rats ignored the lever until the tone was sounded.
"When we stared to play the tone that had been paired with cocaine, the animals began to press the lever at a fairly
high rate. It indicated that the animals had a persistent memory -- they remembered the significance of the tone. We
interpreted the resumption of the lever pressing as a behavioral relapse," West says.
When the rats went through this relapse of drug seeking, the microelectrodes monitoring brain activity showed that
the nerve cells in the accumbens shell responded almost instantaneously when the rats heard the tone.
Before the rats had been conditioned to associate the tone with cocaine, those nerve cells had not responded to the
tone.
Severe sentences no deterrence, say criminologists Harsher sentences do not deter people from committing crimes,
says a new report by University of Toronto criminologists.
One of the objectives of sentencing under the Canadian Criminal Code is to attempt to deter people from committing
crimes, says U of T professor Anthony Doob, who authored the report, Sentence Severity and Crime: Accepting the Null
Hypothesis. "The implication of the law is that harsher sentences will make us safe but our research findings suggest
this isn't true."
Doob and post-doctoral fellow Cheryl Webster examined literature and studies on the deterrent impact of sentences
in the U.S., Canada, England and Australia over the past 30 years. They found that the majority of studies suggest harsher
sentences do not reduce crime. "It's not the penalty that causes people to pause before they commit a crime; it's the
likelihood of being apprehended," says Doob.
Instead of using harsher crimes to discourage people from breaking the law, he says more resources are needed for
social and educational programs for children and youth at various stages in their lives. "Programs that help kids to
thrive in school are good educational investments but they're also good crime prevention investments." ###
Their report will appear in Crime and Justice: A Review of Research, a book to be released in August by the University
of Chicago Press. The report was funded by the Social Sciences and Humanities Research Council and Legal Aid Ontario. CONTACT: Professor
Anthony Doob, Centre for Criminology, 416-978-6438 x 230, anthony.doob@utoronto.ca
SUICIDE RISK AMONG ALCOHOLICS APPEARS TO INCREASE WITH AGE July 15, 2003 (Alcoholism: Clinical & Experimental
Research) -- Researchers know that alcohol disorders amplify suicide risk. At least one-third of individuals who committed
suicide also met criteria for alcohol abuse or dependence; alcohol-use disorders are a potent risk factor for suicide attempts
that are considered medically serious; and up to seven percent of alcoholics die by committing suicide. Suicide risk
among alcoholics also appears to increase with age. A study in the July issue of Alcoholism: Clinical & Experimental Research
(ACER) has found that middle-aged and older alcoholics are at greater risk for suicide than young alcoholic adults.
"Alcoholism is a common disorder and is also a potent risk factor for suicide," said Kenneth R. Conner, assistant
professor at the University of Rochester Medical Center and first author of the manuscript. "This was the first study
of a sample of adults across the age spectrum that explicitly focused on factors that increase the risk for suicide and
medically serious suicide attempts associated with alcohol dependence."
For the purposes of this study, a medically serious suicide attempt was defined as one that required hospital admission
for up to 24 hours and met one other criterion that described the type of treatment received. "Data were gathered from
medically serious attempters because they are a subgroup of suicide attempters who engaged in especially dangerous behavior, suggesting
a high intent to die," said Conner. Even if not successful the first time, he said, these individuals have an elevated
risk of dying in subsequent attempts.
"In most countries, risk for attempted suicide is highest among adolescents and young adults," Conner continued, "whereas
the risk for completed suicide is highest among older adults. This study's findings - that alcohol-dependent middle-aged
and older adults are at greater risk for suicide than alcohol-dependent young adults - reinforce the notion of different
age-related patterns in attempted suicide and completed suicide."
"Little is known about how suicide risk may shift with age," said Paul R. Duberstein, associate professor of psychiatry
and director of the Laboratory of Personality and Development at the University of Rochester Medical Center. "Too often
researchers in this area ignore the role of age, assuming that risk is 'stable' across the life course, as if the risk
for suicide in a 25-year-old alcoholic is identical to that in a 65-year-old alcoholic."
For the ACER study, researchers examined data gathered by Annette L. Beautrais and colleagues for the Canterbury Suicide
Project, a case-control study of suicides, medically serious suicide attempts, and randomly selected comparison subjects
from the Canterbury region of New Zealand. In the analyses, all of the subjects were 18 years of age or older: 193 (149
males, 44 females) had died by committing suicide; 240 (114 males, 126 females) had made a medically serious suicide
attempt; and 984 (476 males, 508 females) were community controls. Researchers compared demographic and diagnostic variables.
Results indicate that the association between alcohol dependence and suicide becomes amplified with age; however,
the association between alcohol dependence and medically serious suicide attempts does not. Increased age also appears
to amplify the association between mood disorders and suicide, whereas decreased age appears to strengthen the association
between mood disorders and medically serious suicide attempts.
"This study shows that suicide risk in alcoholics increases with age," said Duberstein. "This study also shows that
if you have a mood disorder, such as depression, the likelihood of suicide increases as you get older. I think the authors
are absolutely correct in concluding that 'the increased risk for suicide among older adults documented in western cultures
may be attributable in large part to the increased vulnerability of older adults to complete suicide in the context
of alcohol dependence and mood disorders.' Furthermore, the study also challenges the myth that suicide is 'more rationale'
in older adults. Of course, there are rational suicides, but they are the exceptions. Most suicides have a diagnosable
and treatable mental illness at the time of death."
Duberstein said there is a clear need for longitudinal research in order to better understand the mechanisms underlying
the heightened risk of suicide associated with older age, [depression and alcohol dependence.] Conner said he plans
to "examine suicidal behavior among individuals with alcoholism, including a focus on drinking patterns that distinguish
those at especially high risk."
INDIVIDUAL TREATMENT GAINS FAVOR APPROACH EFFECTIVE, CHEAPER, ADHERENTS SAY By Scott Higham and Sewell Chan Washington
Post Staff Writers Wednesday, July 16, 2003; Page A13
EUGENE, Ore. -- Sending teens with troubles to live together in group homes and residential treatment centers didn't
seem to make sense to Patricia Chamberlain. Instead of breaking old habits, the juveniles were learning new ones that
made it more likely that they would be back behind bars or dead before they reached 21.
"We were fighting a losing battle," said Chamberlain, a senior staff member at the Oregon Social Learning Center,
a nonprofit research group based here.
The 54-year-old clinical psychologist came up with a novel idea: Separate the children, put them with highly trained
foster families and closely monitor them. The divide-and-conquer strategy paid off. Researchers found that the teenagers
tended to stay out of trouble. They graduated from high school. Some got full-time jobs. All at a cost far lower than that
of group homes and treatment centers.
Twenty years later, Chamberlain's program, called Multidimensional Treatment Foster Care, is spreading nationwide.
Fifteen cities, including Lynchburg, Va., and Detroit, have adopted her model for juveniles, many with federal grants.
"I like the program because it is very structured," said Richard Boothe, who manages the program for Central Virginia
Community Services, a government-chartered mental health agency in Lynchburg. Twenty teenagers have been through Lynchburg's
program in two years, at a cost of $129 per child per day.
"This is something the nation needs to know about," said Kenyatta Stephens, chief operating officer of Detroit-based
Black Family Development Inc., which is running the new program with the Wayne County juvenile justice department.
Renee Klarich, a supervisor at Black Family Development, said Detroit officials were having a difficult time finding
mental health care for the children and alternatives to group homes and treatment centers. Klarich said the new program
costs $145 per day, compared with $340 at a treatment center.
"If it's well-implemented, not only does it work, but on a cost-benefit analysis it's one of the best things we have
in the nation," said Delbert S. Elliott, chairman of the Center for the Study and Prevention of Violence, a Colorado-based
research group.
The new approach has limitations. Teenagers who have committed rape or murder generally are not accepted, and the
program's biggest successes have so far come in less urban areas, such as Eugene. But officials who examined it as part
of national surveys say the Detroit experience holds promise for urban centers.
In one study of 79 boys, researchers found that juveniles who went through the new program had much lower rearrest
rates than those who went through traditional approaches -- 59 percent vs. 93 percent.
Under the new program, managers recruit foster families and pay them about $1,200 a month. The families then go through
intense child psychology training sessions before teenagers are placed in their homes. The youths receive points for
good behavior, which they can redeem for phone calls, gym visits and trips to the movies. Teams of psychologists, therapists
and social workers monitor the foster families and the children daily.
The program's goal is to reunite children with their families. The teams help those families with parenting skills,
drug and alcohol treatment and other services. For many of the teenagers, the program is a milestone that tends to improve
self-esteem.
"It's one of the most effective programs we have," said Kip Leonard, an Oregon circuit court judge who supervises
juvenile cases in Lane County, which includes Eugene. "We're finally getting smart enough to realize that we can't punish
kids into success."
Shannon and Jerry Stone, a couple who live in the Oregon foothills of the Cascade Mountains, are foster parents in
Chamberlain's program. They heard about it from their pastor, enrolled in the program 11 years ago and learned how to
deal with difficult children.
"You don't feel like you're the Lone Ranger," said Jerry Stone, 52, a welding supervisor for a Caterpillar tractor
shop.
"It makes so much sense," said Shannon Stone, 51, a church preschool teacher. "Instead of dealing with one little
piece of the puzzle, we're dealing with everything."
The couple currently is trying to help a 13-year-old boy who was sexually abused and now is charged in juvenile court
with menacing and physical harassment. The boy's soft brown eyes and little-kid crew cut belie a barely contained rage,
the Stones say. He was known to lash out at the slightest provocation.
But the boy, whose name is being withheld because of his age, is doing better. Last year, he was tossed out of school
35 times. This year, in a new school, he had a 3.2 grade-point average.
Sitting on a sofa in the Stones' living room one day this year, the boy said he is learning to get along with those
around him.
"I'm not ready to go home," the boy said with a mischievous smile. "I still have a little bit of an attitude." Chan
reported from Washington. (c) 2003 The Washington Post Company
News Thursday, July 17, 2003 HEROIN ADDICTS GET NEW TREATMENT Oregon is to be a testing ground for the drug
therapy. SUSAN TOM Statesman Journal July 14, 2003 A major push to attack Oregon's stubborn heroin problem is set to
begin today.
Health experts are optimistic that a new treatment called buprenorphine will reach addicts in ways that standard methadone
treatment cannot.
Some of those federal and state officials will be in Portland today as part of a 14-stop tour. They chose the city
because heroin and narcotic pain medications were among the leading drugs that killed people in Portland and surrounding
counties in 2001.
Of the 157 drug-abuse related deaths that year, 84 involved heroin or morphine and 50 involved narcotic pain medications,
according to the Substance Abuse and Mental Health Services Administration.
Now, help is on the way under the brand names Subutex and Suboxone. The Food and Drug Administration has approved
the drugs for use in treating addictions to heroin and prescription pain relievers such as Vicodin.
Dr. Ron Schwerzler, director of medicine at Serenity Laneis Eugene clinic, predicts that methadone will be a thing
of the past in a couple of years. He already uses buprenorphine to ease heroin withdrawal symptoms for about 20 patients
and has had good results.
Buprenorphine has several advantages over methadone, the most common treatment for heroin addiction.
Unlike methadone, which usually is dispensed in special drug treatment clinics such as the Marion County program,
buprenorphine can be prescribed in a doctor's office.
That will make it easier for patients in remote areas who otherwise would have to travel several hours to a methadone
clinic, said Jerry Gjesvold, statewide coordinator of employer services at Serenity Lane, a drug treatment program.
Estimates are that only about 20 percent of heroin addicts are on methadone, largely because of lack of access.
"If they (recovering addicts) are not able to get to it, they'll start street-drug seeking," Gjesvold said.
The number of methadone clinics and the number of patients who can afford treatment are both dwindling, the result
of state budget cuts.
Crys Morris of Albany, a 26-year-old student who has been in the Marion County methadone program for four years, said
she was interested in the new therapy because of the convenience.
Although she has her own car now, Morris can remember a number of close calls, especially during the first 90 days
of the program when she had to be at the clinic daily.
"I didn't even know if I'd even get up here," she recalled. "What do you do, hitchhike? A taxi is about $50."
The side effects of buprenorphine also are less severe than those of heroin and methadone, and there is a lower risk
of potential abuse and overdose, according to SAMHSA.
There are some restrictions, though.
Doctors are limited to 30 patients at a time and must complete eight hours of mandatory training. Additionally, the
drug does not relieve pain, the main reason patients take prescription drugs like Vicodin.
More than 3,000 doctors have received training and more than 1,500 of them got the OK to start prescribing the drug
to patients.
Dr. Walt Byrd, the physician at Marion County's methadone program, is one of 18 Oregon doctors who have met all the
requirements.
Buprenorphine has minimal side effects and it may help some trying to get off methadone, Byrd said, but it will never
replace methadone. He has put two patients on the new therapy so far and intends to prescribe buprenorphine at his private
practice in Lake Oswego.
"It's (buprenorphine) more expensive," Byrd said, comparing the new drug to methadone. "That's one of the problems."
Gloria Thefford, the methadone clinic supervisor, agreed that adding buprenorphine therapy is not as easy as it seems.
For starters, Marion County has to find a doctor trained in the new therapy before the option can be offered to methadone
clinic clients.
"It's not quite the panacea many initially thought, but it has incredible potential," Thefford said.
Susan Tom can be reached at (503) 399-6744.
Copyright 2003 Statesman Journal, Salem, Oregon
WHAT MAKES TEENS DO DRUGS July 25, 2003 FRIDAY, July 25 (HealthDayNews) -- Teenage boys who drink, smoke and use drugs
are influenced more by family and friends while genes are more likely to increase the risk of substance abuse in teenage
girls, says a Virginia Commonwealth University study.
"Our findings show that risk factors for substance abuse are different in boys and girls," researcher Judy L. Silberg,
an assistant professor of human genetics, says in a news release.
"In girls, there was a significant genetic influence on all substance abuse in adolescence. But, with boys, environmental
factors, including a dysfunctional family and peers who use drugs and alcohol, had a pervasive influence," Silberg says.
She and her colleagues examined data collected over three years on 1,071 adolescent twin girls and boys, aged 12 to
17, taking part in the Virginia Twin Study of Adolescent Behavioral Development.
Their statistical analysis revealed that no single risk factor was to blame for substance abuse in male or female
teens. In both girls and boys, genetics and environment were factors, but their degree of influence varied for boys
and girls.
The study findings could affect the way that teens are treated for substance abuse.
"Because girls' use of substances is controlled by the same genes that are linked to behavioral problems, treatment
efforts that target the antisocial behavior itself may be effective. Boys' substance use may be reduced by directly
altering those family and peer characteristics that are most influential," Silberg says.
The study appears in the July issue of the Journal of Child Psychology and Psychiatry and Allied Disciplines .
BLACK FAMILIES' GAINS OFFSET BY INCARCERATION, JOBLESSNESS, REPORT SAYS By DEBORAH KONG, AP MINORITY ISSUES WRITER
(AP) - Black families' gains in income and education are being undermined - at least to some degree - by rising incarceration
rates and a persistent unemployment gap compared with whites, the Urban League says in its latest report on the state
of black America.
Black families are "strong but challenged," said Urban League President Marc Morial. "More black families are counted
to be middle income, the number of black businesses are up. But then on the other hand, a higher proportion of black
men are in jail and the black unemployment rate, after declining significantly, is back up."
The annual report, scheduled for formal release Wednesday, is a collection of nine essays written by experts in race,
social justice, health, psychology and civil rights. Black families have been a recurring theme since it was first published
in 1976.
Three decades after he first wrote about black families for the Urban League, Robert Hill, a senior researcher at
the Rockville, Md., research firm Westat, examines how the social and economic status of black families has changed.
Racism remains, he writes. In the last 30 years, "there has been a strong shift from Jim Crow - the overt manifestation
of racial hatred by individuals and white society - to James Crow, Esquire - the maintenance of racial inequality through
covert processes of structure and institutions," he says.
Though blacks are no more likely than whites to mistreat their children, they are over-represented in the foster care
system, he says. Nationally, black children comprise about one in five children, but account for almost half of the
550,000 in foster care.
Teen pregnancy contributes to the instability of black families - black teens are about three times more likely than
whites to have out-of-wedlock babies, Hill says. Other factors which have hurt black families, he says, include: urban
renewal efforts, which displaced many blacks and created segregated high-rise public housing; drug use, and the AIDS epidemic.
Economically, a decline in manufacturing and the rise of service industries meant many black workers went from higher-paying
blue-collar jobs to much lower-paying white-collar service jobs, he says.
Blacks have made little progress in narrowing the jobless gap with whites. In June, the national unemployment rate
for whites was 5.5 percent; for blacks, 11.8 percent. In 1972, the jobless rate among whites was 5.1 percent; for blacks,
10.4 percent.
And while black families' median income increased, it still remains at only 60 percent of white families', Hill says.
But black families also have demonstrated continued strengths through their strong desire to see children go to college,
work ethic, support provided by extended family members and their religious faith, which has helped upward mobility
among blacks, Hill says.
Other essays in the report focus on stresses to black families, including:
- An increase in the black population in prisons. Though blacks make up about 12 percent of the nation's population,
they account for nearly half of the people in prison, says Ernest Drucker, author of an essay on incarceration.
That divides families - more than half of incarcerated men have children who are minors, Drucker says.
The incarceration disparities have been fueled by drug enforcement policies that have harsher effects on blacks, says
James Lanier of the Urban League's Institute for Opportunity and Equality. He cites data showing that blacks account
for 13 percent of the nation's drug users, but 35 percent of drug arrests and 53 percent of drug convictions.
- A child care shortage that is especially prevalent in poor, urban counties where many blacks live.
- Lesbian, gay, bisexual and transgender families are an integral part of the black community but are still not recognized
by some. About 40 percent of women, 18 percent of men and 15 percent of transgender people surveyed at Black Pride celebrations
in nine cities said they had at least one child.
The report, which also includes essays on black feminism, black girls and their families, the legacy of sociologist
E. Franklin Frazier and a special section on affirmative action, is to be released at a news conference in Washington.
Cannabis link to psychosis Sarah Boseley, health editor Thursday July 3, 2003 The Guardian Very heavy use of
cannabis could be a cause of psychosis, according to a leading psychiatrist who believes that society should think carefully
about the potential consequences of its increasing use.
Robin Murray, professor of psychiatry at the Institute of Psychiatry and consultant psychiatrist at the Maudsley hospital
in London, says that in the last 18 months, there has been increasing evidence that cannabis causes serious mental illness.
In particular, a Dutch study of 4,000 people from the general population found that those taking large amounts of cannabis
were almost seven times more likely to have psychotic symptoms three years later.
"This research must not be ignored," said Prof Murray, speaking at the annual general meeting of the Royal College
of Psychiatrists in Edinburgh.
Writing in the Guardian last August, Prof Murray said he had been surprised that the discussion around cannabis had
skirted around the issue of psychosis.
Psychiatrists had known for 150 years that very heavy consumption of cannabis could cause hallucinations and delusions.
"This was thought to be very rare and transient until the 1980s when, as cannabis consumption rose across Europe and
the USA, it became apparent that people with chronic psychotic illnesses were more likely to be regular daily consumers
of cannabis than the general population."
In the UK, he said, people with schizophrenia are about twice as likely to smoke cannabis. The reason appears to be
the effect that the drugs have on chemicals in the brain. "In schizophrenia, the hallucinations and delusions result
from an excess of a brain chemical called dopamine. All the drugs which are known to cause psychosis - amphetamine,
cocaine and cannabis -increase the release of dopamine in the brain."
Cannabis had been the downfall of many a promising student, he suggested. "Like any practising psychiatrist, I have
often listened to the distraught parents of a young man diagnosed with schizophrenia tell me that as a child their son
was very bright and had no obvious psychological problems. Then in his mid-teens his grades began falling. He started
complaining that his friends were against him and that people were talking about him behind his back.
"After several years of increasingly bizarre behaviour, he dropped out of school, job or university; he was admitted
to a psychiatric unit overwhelmed by paranoid fears and persecution by voices. The parents tell me that, at some point,
their son was heavily dependent on cannabis."
It used to be thought that the high numbers of psychotic patients taking cannabis could be explained because they
used it to alleviate their symptoms. The recent studies, however, have looked at large populations without mental illness
and studied the numbers of cannabis takers within them who have developed psychosis.
STUDY: POT DOESN'T CAUSE PERMANENT BRAIN DAMAGE Fri Jun 27,12:18 AM ET By Deena Beasley LOS ANGELES (Reuters)
- Smoking marijuana will certainly affect perception, but it does not cause permanent brain damage, researchers from
the University of California at San Diego said on Friday in a study.
"The findings were kind of a surprise. One might have expected to see more impairment of higher mental function,"
said Dr. Igor Grant, a UCSD professor of psychiatry and the study's lead author. Other illegal drugs, or even alcohol,
can cause brain damage.
His team analyzed data from 15 previously published, controlled studies into the impact of long-term, recreational
cannabis use on the neurocognitive ability of adults.
The studies tested the mental functions of routine pot smokers, but not while they were actually high, Grant said.
The results, published in the July issue of the Journal of the International Neuropsychological Society, show that
marijuana has only a marginally harmful long-term effect on learning and memory.
No effect at all was seen on other functions, including reaction time, attention, language, reasoning ability, and
perceptual and motor skills.
Grant said the findings are particularly significant amid questions about marijuana's long-term toxicity now that
several states are considering whether to make it available as a medicinal drug.
In California, growing marijuana for medical purposes is legal under a voter-approved law.
The UCSD analysis of studies involving 704 long-term cannabis users and 484 nonusers was sponsored by a state-supported
program that oversees research into the use of cannabis to treat certain diseases.
Anecdotal evidence has shown that marijuana can help ease pain in patients with diseases like multiple sclerosis or
prevent severe nausea in cancer patients, but the effects have yet to be proven in controlled studies, Grant said.
The UCSD research team said the problems observed in learning and forgetting suggest that long-term marijuana use
results in selective memory defects, but said the impact was of a very small magnitude.
"If we barely find this tiny effect in long-term heavy users of cannabis, then we are unlikely to see deleterious
side effects in individuals who receive cannabis for a short time in a medical setting," Grant said.
In addition, he noted that heavy marijuana users often abuse other drugs, such as alcohol and amphetamines, which
also might have long-term neurological effects.
Some of the research studies used in the analysis were limited by the numbers of subjects or insufficient information
about factors like exposure to other drugs or whether participants suffered from conditions like depression or personality
disorders.
"If it turned out that new studies find that cannabis is helpful in treating some medical conditions, this enables
us to see a marginal level of safety," Grant said.
MANY GAY, BISEXUAL MEN REPORT UNSAFE SEX: STUDY Tue June 24, 2003 06:21 PM ET NEW YORK (Reuters Health) - A
large percentage of gay and bisexual men say they have had unsafe sex in recent months, putting themselves at risk of
HIV and other sexually transmitted diseases, a new study has found.
Among nearly 4,300 gay or bisexual men in six U.S. cities, around half said they had had unprotected anal sex during
the past six months, researchers report in the American Journal of Public Health.
The findings "emphasize the continued need for effective behavioral strategies designed to prevent HIV infection among
men who have sex with men," write Dr. Beryl A. Koblin, of the New York Blood Center in New York City, and colleagues.
Their results are based on interviews with 4,295 gay or bisexual men participating in the ongoing EXPLORE study, which
is aiming to identify risk behaviors that may be fueling HIV transmission in the U.S.
Every six months the study participants undergo counseling regarding their sexual behavior and get tested for HIV
and other STDs.
All of the men were HIV-negative at the start of the study and reported that they had had anal sex during the six
months prior to the study, which began in 1999.
Overall, men who said they'd had multiple sexual partners in recent months were no more likely to have used a condom
than those who said they had only one primary partner -- a finding Koblin's team says is "of particular concern" since
the former group is at increased STD risk.
In addition, unprotected anal sex was much more common when drugs and alcohol were involved, the researchers found.
The HIV epidemic among gay and bisexual men in the U.S. "continues to be a major public health issue," Koblin's team
writes.
"Our findings," they conclude, "support the continued need for effective intervention strategies for men who have
sex with men that address relationship status, (HIV status) of partners and drug and alcohol use."
SOURCE: American Journal of Public Health 2003:93:926-932.
Yale University Adolescents are neurologically more vulnerable to addictions New Haven, Conn. -- Adolescents
are more vulnerable than any other age group to developing nicotine, alcohol and other drug addictions because the regions
of the brain that govern impulse and motivation are not yet fully formed, Yale researchers have found.
After conducting an analysis of more than 140 research studies from across the basic and clinical neurosciences, including
many conducted at Yale, the researchers concluded that substance use disorders in fact constitute neurodevelopmental
disorders.
"Several lines of evidence suggest that sociocultural aspects particular to adolescent life alone do not fully account
for greater drug intake," said Andrew Chambers, M.D., assistant professor of psychiatry at Yale School of Medicine and
lead author of the study published this month in the American Journal of Psychiatry. "And while we strongly suspect
that genetic factors in individuals can lower the threshold of drug exposure required for 'tripping the switch' from
experimental to addictive drug use, here we have a phenomena where a neurodevelopmental stage common to virtually everyone
regardless of genetic make-up confers enhanced neurobiological vulnerability to addiction."
Chambers said that this perspective is possible when viewing brain systems involved in motivation and addiction as
distributed components that undergo unique developmental histories.
"Particular sets of brain circuits involved in the development of addictions are the same ones that are rapidly undergoing
change during adolescence," he said. "Normally these processes cause adolescents to be more driven than children or
adults to have new experiences. But these conditions also reflect a less mature neurological system of inhibition, which
leads to impulsive actions and risky behaviors, including experimentation and abuse of addictive drugs."
"Because of developmental changes in brain regions concerned with the formation of adult motivations, the actions
of drugs in those regions to cause addiction may occur more rapidly and potentially with greater permanency," Chambers
said.
He said the implications of this review are that addictions should be viewed as developmental disorders and that researchers
should concentrate on the adolescent period when considering treatment and prevention of addictions. Also, it highlights
the importance of researching the impact of current psychotropic medication treatment practices in childhood and adolescence
on the incidence of addictions in adulthood.
"The identification of adolescent subgroups with heightened vulnerability to substance abuse disorders, development
of evidence-based preventative strategies, and refinement of pharmacotherapeutic and psychosocial treatments are important
areas to pursue in order to reduce the large impact of substance use disorders upon society," he said. ###
Co-authors included Jane Taylor and Marc Potenza, M.D., both in the Department of Psychiatry.
The study was supported by a Veterans Administration Special Neuroscience Research Fellowship Grant and grants from
the National Alliance for Research on Schizophrenia and Depression, the National Institute on Drug Abuse, the American
Psychiatric Association and the National Center for Responsible Gaming.
Locked up in land of the free Inmates: The United States has surpassed Russia as the nation with the highest percentage
of citizens behind bars. By Scott Shane Originally published Jun 1, 2003 With a record-setting 2 million people locked
up in American jails and prisons, the United States has overtaken Russia and has a higher percentage of its citizens behind
bars than any other country. Those are the latest dreary milestones resulting from a two-decade imprisonment boom that
experts say has probably helped reduce crime but has also created ballooning costs and stark racial inequities. Overseas,
U.S. imprisonment policy is widely seen as a blot on a society that prides itself on valuing liberty and just went to war
to overturn Saddam Hussein's despotic rule in Iraq. "Why, in the land of the free, should 2 million men, women and children
be locked up?" asks Andrew Coyle, director of the International Centre for Prison Studies at the University of London and
a leading authority on incarceration. When he discusses crime and punishment with foreign colleagues, Coyle says, the
United States is such an anomaly that it must often be left out of the discussion. "People say, 'Well, that's the United States.'
They see the U.S. as standing entirely on its own," he says. The latest statistics support that view. The new high of
2,019,234, announced by the Justice Department in April, underscores the extraordinary scale of imprisonment in the United
States compared with that in most of the world. During the 1990s, the United States and Russia vied for the dubious position
of the highest incarceration rate on the planet. But in the past few years, Russian authorities have carried out large-scale
amnesties to ease crowding in disease-infested prisons, and the United States has emerged unchallenged into first place, at
702 prisoners per 100,000 population. Russia has 665 prisoners per 100,000. Today the United States imprisons at a far
greater rate not only than other developed Western nations do, but also than impoverished and authoritarian countries do.
On a per capita basis, according to the best available figures, the United States has three times more prisoners than
Iran, four times more than Poland, five times more than Tanzania and seven times more than Germany. Maryland has more citizens
in prison and jail (an estimated 35,200) than all of Canada (31,600), though Canada's population is six times greater. "This
is a pretty serious experiment we've been engaged in," says Vincent Schiraldi, director of the Justice Policy Institute, a
Washington think tank that supports alternatives to prison. "I don't think history will judge us kindly." Bruce Western,
a sociologist at Princeton University, says sentencing policies have had a glaringly disproportionate impact on black men.
The Justice Department reports that one in eight black men in their 20s and early 30s were behind bars last year, compared
with one in 63 white men. A black man has a one-in-three chance of going to prison, the department says. For black male
high school dropouts, Western says, the numbers are higher: 41 percent of black dropouts between ages 22 and 30 were locked
up in 1999. "I think this is one of the most important developments in race relations in the last 30 years," he says.
Some conservative analysts say that however regrettable the prison boom has been, it's working. It's no anomaly that the
prison population is still rising despite a decade-long fall in the national crime rate, they say, but rather cause and effect.
"If you put someone in prison, you can be sure they're not going to rob you," says David B. Muhlhausen, a policy analyst
at the Heritage Foundation. "Quality research shows that ... increasing incarceration decreases crime." Considering that there
are still about 12 million serious crimes a year, Muhlhausen says, "maybe we're not incarcerating enough people." Miscreants
have been locked up for centuries, but today's prisons are the legacy of 19th-century reformers' desire to rehabilitate wrongdoers
rather than punish them with whipping, dunking in water or being displayed in public stocks. Quaker influence was behind
the creation in 1829 of Philadelphia's Eastern State Penitentiary, often considered the first modern American prison. It took
a century and a half, until 1980, to reach 500,000 inmates. Then, in slightly more than 20 years, the prison and jail population
grew by 1.5 million. A major cause of the increase is the war on drugs. In 1980, says Marc Mauer, assistant director of
the Sentencing Project in Washington, about 40,000 Americans were locked up solely for drug offenses. Now the number is 450,000,
three-fourths of them black or Hispanic, although drug use is no higher in those groups than among whites. "Drug abuse
cuts across class and race," says Mauer, author of Race to Incarcerate. "But drug law enforcement is focused on low-income
neighborhoods." Alfred Blumstein, a criminologist at Carnegie-Mellon University, says locking up drug dealers does not
necessarily reduce their number, because new recruits quickly take their place. The well-established penal theory of "incapacitation,"
Blumstein says, dictates that "if a guy's committing 10 crimes a year and you lock him up for two years, you've prevented
20 crimes," Blumstein says. "That works for rape and robbery. But with drugs, there's a resilient market out there. The incarceration
of drug offenders is largely an exercise in futility." A second major reason for the rise in imprisonment is the politically
popular shift to longer sentences with mandatory minimums, "three-strikes" laws and "truth-in-sentencing" measures to eliminate
early parole. "Since the 1970s, there's been a growing politicization of punishment policy," Blumstein says. "It's the
30-second sound bite of the prison door slamming, with the implicit promise, 'Vote for me and I'll slam the door.'" A tough
stance on sentencing usually wins votes, whether or not it ultimately reduces crime. Blumstein says the most rigorous
recent studies suggest that about 25 percent of the drop in crime in recent years resulted from locking up more criminals.
The rest resulted from other factors, among them the ebbing of the crack cocaine epidemic, changed policing strategies and
the strong economy of the 1990s. Now, with many state budgets in crisis, there are hints of a turnaround. Justice Department
figures show that nine states reduced their prison populations last year, including Texas, Illinois and New York. The
number of prisoners was still rising in far more states, including Maryland, where the prison population - excluding jails
- has more than tripled since 1980, to about 24,000. But many governors and legislators are wondering whether they can
afford to house more and more offenders at an average of $25,000 a year apiece. "Even some of your more right-wing people
are saying, 'Let's see what we can do to get some people out of prison to save some money,'" says Reginald A. Wilkinson, director
of the Ohio Department of Rehabilitation and Correction and president of the association of state prison chiefs. Like
many prison professionals, Wilkinson says, "I always thought we locked up too many people." He says he's taking advantage
of the budget squeeze to push for cheaper alternatives. Ohio's state prison population has fallen from its 1998 high of 49,000
to 45,000, and two prisons have been closed, he says. In Maryland, there's no talk of closing prisons. Major expansions
are planned or under way at North Branch Correctional Institution near Cumberland and Eastern Correctional Institution on
the Eastern Shore to add 396 beds to the crowded system. "Maryland would seem to be stuck in neutral," says Judith A.
Greene, a senior fellow at the Justice Policy Institute who has tracked the beginning of a turnaround in other states. Gov.
Robert L. Ehrlich Jr. and his secretary of public safety and correctional services, Mary Ann Saar, have said they want to
use drug treatment and closer supervision of parolees to keep former offenders from returning to prison. Saar's planned
programs "all have the goal of getting people out of prison and keeping them out," says Mark A. Vernarelli, director of public
information for the department of public safety. Still, he adds, given the steady flow of prisoners sent by the courts, "we
maintain a constant vigil for land for new prisons."
Reported June 6, 2003 Substance Use Among Teens (Ivanhoe Newswire) -- Researchers know high levels of drug
and alcohol use in teens can lead to psychiatric problems. Now, a new study shows lower levels of use are cause for
concern as well.
Investigators believe this result, outlined in the current issue of Pediatrics, points to a greater need to identify
substance use among teenagers during primary care physician visits.
The study was conducted among about 500 teens aged 14 to 18 years who were receiving routine care in an adolescent
clinic. All teens completed standard screenings aimed at gauging their level of substance use and the presence of psychiatric
symptoms. The teens were classified into three groups according to their use of drugs and alcohol: those who weren't
using substances or had no problems with them (66 percent), those who were using substances and having some problems
(18 percent), and those diagnosed with substance use disorders (16 percent).
At least one type of psychiatric problem was noted in 80 percent of all the teenagers, with symptoms of anxiety being
the most common in both boys and girls. When compared with the nonproblematic group, however, results showed teens with
either substance use problems or disorders were more likely to suffer several psychiatric problems. Girls with substance
use problems or disorders were more likely to report symptoms of mania, attention deficit disorder, and conduct disorder.
Girls with disorders had an increased risk of depression, eating disorders, and hallucinations or delusions.
Boys with substance use problems were more likely to have attention deficit disorder symptoms, and boys identified
with substance use disorders had a greater risk of hallucinations or delusions. Boys in both substance use categories
were more likely to report conduct disorder symptoms.
Overall, both boys and girls with substance use problems or disorders are at increased risk for higher psychiatric
symptom scores and a wider range of psychiatric symptoms than those who aren't having any problems with substance use.
This article was reported by Ivanhoe.com, who offers Medical Alerts by e-mail every day of the week. To subscribe,
go to: http://www.ivanhoe.com/newsalert/. SOURCE: Pediatrics, 2003;111:699-705
Monday, June 2, 2003 Brown University News Service Contact: Scott Turner mailto:News_Service@brown.eduNICOTINE CHANGES NEWBORN BEHAVIOR SIMILAR TO HEROIN AND CRACK For the first time, researchers report that nicotine
exposure in the womb produces behavioral changes in babies similar to those found in newborns of women who use crack
cocaine or heroin during pregnancy. The study by Brown Medical School researchers appears in the June issue of Pediatrics. PROVIDENCE,
R.I. A new study suggests that even casual smoking during pregnancy harms a fetus, producing behavioral changes similar to
those in babies born to mothers who use illegal drugs.
Women who smoke just 6 to 7 cigarettes per day give birth to babies who are more jittery, more excitable, stiffer
and more difficult to console than newborns of nonsmokers, report Brown Medical School researchers in the June issue
of the journal Pediatrics. The higher the dose of nicotine measured in a mother, the greater the signs of stress in
her new baby.
This is the first research paper to show that nicotine exposure in the womb produces behavioral changes in babies
similar to those found in newborns of women who use crack cocaine or heroin while pregnant. The data suggest "neonatal
withdrawal" from nicotine, said the authors.
"We have a legal drug in nicotine that may have the same toxic effect as illegal drugs," said Karen L. Law, who led
the study. Law suggests that public health officials consider stop-smoking interventions that would produce healthy
newborns for women who currently smoke.
"These findings require us to take a step back," she said. "What are Surgeon General warnings doing to stop smoking,
given that the percentage of smokers is similar in the pregnant and general populations (about 18 percent and 25 percent
respectively)? It is a huge public health concern that so many people are suffering the costs of smoking, including
newborns."
Brown researchers are conducting a follow-up study of tobacco-exposed infants in their first month of life to better
understand the lingering effects from nicotine.
Previous research has linked as few as 10 cigarettes daily during pregnancy to low birth weight babies. The Brown
study lowers the threshold for causing fetal impairment to 6 to 7 cigarettes a day. This new study opens the door to
further research, said Law. "We don't know if a woman quits smoking six months into pregnancy will that make a difference?
Given that we have found a behavioral outcome in newborns at a lower dose of six cigarettes a day, would we find an effect
at three cigarettes as well?"
The study, conducted at Women & Infants Hospital of Rhode Island, involved 27 tobacco-exposed and 29 unexposed
full-term newborn infants from comparable social backgrounds with no medical problems. The "nicotine" infants were more
excitable, abnormally tense and rigid, required more handling and showed greater stress, specifically in their central
nervous, gastrointestinal and visual systems.
To some extent, "this is science shaped by culture," said Barry Lester, senior author of the study and an expert on
maternal drug exposure. "We tolerate smoking in ways that we don't tolerate drugs. Eighteen percent of women smoke in
pregnancy. About 3 to 5 percent of pregnant women use cocaine. Yet everyone is worried about cocaine."
If cigarettes cause a fetus the same injury as illegal drugs, "do we yank newborn babies from women who smoked during
pregnancy?" Lester said. "Here, a legal drug is showing the same effects as an illegal substance for which protective
services will remove babies from their mothers. We have not faced this policy question about a legal drug before, because
this scientific information was not available. We need to re-look at how we evaluate a fit mother."
Tobacco-exposed babies could flourish, with the proper child rearing, said Lester. "You have to apply the findings
in context," he said. "Yes, this is correctable. If a behaviorally vulnerable baby receives attention and care, there
is no reason to think that the child won't thrive. But we also know that the same baby is at risk for a poor developmental
outcome if that child grows up in a stressed, low-income environment, where effects of exposure get exaggerated."
To conduct the study, Law collected self-reports of smoking from new mothers. She correlated the information with
a biological marker of nicotine, called cotinine, collected from saliva of the mothers. This is the first study of its
kind to include cotinine. Law also conducted a behavioral exam for newborns within 48 hours of birth, designed to measure
drug effects. Women were excluded from the study for use of illegal drugs, antidepressants and alcohol. All babies were
full-term, and the researchers controlled for low birth-weight and other factors.
Law conducted the study as a senior at Brown, where she is now a third-year medical student. She led a six-member
team of specialists in infant development, addiction behavior and smoking cessation. The study was supported in part
by a Brown Medical School Summer Research Fellowship and by grants from the National Cancer Institute and the Department
of Psychiatry and Human Behavior at the Brown Medical School.
Behavioral treatment may reverse brain changes that occur with cocaine use and help prevent relapse NIH/National
Institute on Drug Abuse Brain changes that occur with cocaine use and the tendency toward relapse may be reduced by
a behavioral treatment using extinction training--a form of conditioning that removes the reward associated with a learned
behavior. NIDA-funded researchers found that extinction training during cocaine withdrawal produces changes in brain
receptors for glutamate, a brain chemical found in the nucleus accumbens, the reward center of the brain. A reduction in
glutamate input from cortical brain regions by chronic cocaine use is thought to contribute to persistent cravings for
the drug.
The researchers trained rats to self-administer cocaine by pressing a lever and to associate the availability of cocaine
with certain environmental cues (lights and noise). Once the rats had learned to expect cocaine when they pressed the
lever, cocaine and the cues were removed so that the rats did not receive the cocaine that they were anticipating. One
group of rats received this extinction training during cocaine withdrawal while another group did not receive the training.
After extinction training was over, the researchers exposed the rats to the cocaine-associated cues and administered cocaine
to induce relapse.
The researchers found that the rats given extinction training during withdrawal had more than a 30 percent increase
in glutamate receptors in the outer regions of their nucleus accumbens. The number of glutamate receptors did not increase
in rats that did not receive the training during withdrawal. When cocaine-related cues were reinstated, rats showing
relatively no response to these stimuli had a greater increase in receptors than rats that responded to the cues.
WHAT IT MEANS: These findings indicate that behavioral-based treatment approaches have the potential to reverse or
lessen the harmful neurobiological and behavioral consequences of chronic drug use. Increasing the number of glutamate
receptors may help ease cravings for cocaine during abstinence and also help prevent relapse.
This study was published by lead investigator Dr. David Self at the University of Texas Southwestern Medical Center
in the January issue of Nature.
Drug Study Promising for Heavy Drinkers The Washington Post - May 16, 2003 A drug with a novel mechanism of action
reduced the craving for alcohol among heavy drinkers and may help alcoholics quit or seriously reduce their drinking,
researchers reported yesterday.
The medicine, topiramate, which is marketed to control seizures, was found to be effective in a trial with 150 volunteers
conducted at the University of Texas at San Antonio, said lead investigator Bankole Johnson, a psychiatrist.
"We think it's very significant," he said in an interview. In a comparison of those taking the drug with those
receiving placebo pills and behavioral counseling, the drug "is four times better in terms of heavy drinking and eight
times better in terms of complete abstinence."
The Food and Drug Administration has not approved the medicine, which appears to affect the brain's ability to experience
the pleasure of drinking and to reduce the craving for alcohol, for treating alcoholism. The study would have to be
replicated in larger groups before doctors could recommend it.
Still, federal researchers and others agreed that it could open a new front in the treatment of alcohol abuse, which
afflicts about 14 million Americans -- one in every 13 adults. Alcohol abusers are defined as men who have five or
more drinks per day and women who have four or more drinks each day.
Unlike traditional alcohol abuse studies, which usually examine the effectiveness of medicines and psychological
interventions in keeping alcoholics from drinking at all, Johnson's study involved volunteers who were active heavy
drinkers. The results were published in the Lancet medical journal.
"The results were very promising," said Raye Litten, chief of the Treatment Research Branch at the National Institute
on Alcohol Abuse and Alcoholism.
Large studies are underway to measure the effects of combining other medications with a range of psychosocial therapies.
Topiramate may be especially effective in easing the symptoms of withdrawal, said Robert Swift, an alcohol abuse
researcher at Brown University.
Doctors believe that most alcoholics require treatment with multiple approaches, including other medicines and psychological
or religious techniques, to quit drinking and stay sober. Since many alcoholics go back to the bottle, doctors have
come to mark victory against alcohol abuse in modest terms -- keeping people sober for periods of time rather than expecting
them to quit permanently.
"Alcoholism is not a homogenous disease, so there is no magic bullet out there to treat" it, Litten said. "There
is a biological component and a psychological component and a cultural component and a social component, and they
vary from individual to individual."
Two medicines are approved to treat alcohol abuse -- disulfiram, sold under the trade name Antabuse, makes drinkers
feel sick if they drink, while the better known naltrexone, sold as ReVia or Depade, appears to reduce the pleasure
in drinking, Swift said.
Johnson pointed out that all the patients taking topiramate in his study -- even those still drinking -- were no
longer consuming dangerous amounts of alcohol.
"We are able to get practically everybody drinking close to nothing, and the ones who are still drinking are not
drinking as much," he said.
The study measured the effectiveness of topiramate -- which is sold under the brand name Topamax -- among 150 heavy
drinkers. Half received the medicine and low-intensity counseling, while the other half received placebo pills and the
same counseling.
The average person in the topiramate group was drinking 9.59 drinks a day upon beginning the study, compared with
8.85 drinks a day in the placebo group. Participants were asked to keep track of how much they drank, and even before
they began taking medication their consumption dropped dramatically -- an indication of the role social factors play in
alcohol abuse.
By the end of the three-month trial, patients taking topiramate were down to 1.5 drinks a day, while those taking
the placebo were down to 3.36 drinks a day.
Johnson said 13 or 14 patients in the topiramate group quit entirely and stayed sober, while only two from the placebo
group stopped drinking altogether.
Topiramate is sold in the United States by Ortho-McNeil Pharmaceutical of Raritan, N.J., which provided the pills
and some funding. Most of the funding came from Johnson's own department. The researcher said he owns no stock in the
company and would not financially benefit if the FDA approved the medicine for treating alcohol abuse.
Stephanie Scott, a spokeswoman for the company, said, "Right now, all we can say is the results are promising and
would warrant some future investigation. We are not actively pursuing an indication for alcoholism for this compound."
Johnson's study did not report any severe side effects, but a recent study of topiramate in epileptics, conducted
by Kimford J. Meador, chairman of the Neurology Department at Georgetown University Medical Center, found that some experienced
severe side effects unless they started at low doses and built up gradually.
Contact: Hannelore Ehrenreich, M.D., D.V.M. ehrenreich@em.mpg.de49-551-3899628 (Germany) Max-Planck-Institute for Experimental Medicine Add'l Contact: Claudia Spies, M.D. claudia.spies@charite.de 49-30-450-531052 (Germany) University Hospital Charite Campus MitteCHRONIC ALCOHOL ABUSE DAMAGES REGULATING HORMONES *
Chronic alcohol consumption is associated with higher rates of infections, cardiomyopathy, cardiac arrhythmias, bleeding
complications and liver insufficiency. * Alcohol withdrawal and early abstinence also wreak havoc on alcoholics. *
New research indicates that changes in hormones that regulate electrolyte and water balance in the body may not only account
for some withdrawal symptoms but persist over long periods of strictly controlled abstinence.
Although it is well known that chronic alcohol abuse causes a broad range of health complications, it remains unclear
how much regeneration may occur during long-term abstinence from alcohol. A new study carefully monitors major water
and electrolyte regulating hormones - arginine vasopressin (AVP), atrial natriuretic peptide (ANP), aldosterone and angiotensin
II - from early withdrawal up to 280 days of strict abstinence. The results, published in the May issue of Alcoholism:
Clinical & Experimental Research, indicate that chronic alcohol abuse can cause severe and persistent alterations
in the hormones that regulate electrolyte and water balance in the body.
"Most of the available literature on regeneration from alcoholism is restricted to the first few days up to three
weeks of abstinence," said Hannelore Ehrenreich, head of Clinical Neuroscience at the Max-Planck-Institute for Experimental
Medicine and corresponding author for the study. "Only rarely do papers report on persistent alterations or on patterns
of regeneration associated with long-term abstinence. In fact, many disturbances are believed - but never proven - to return
to normal within a few weeks."
"Both chronic alcohol consumption and alcohol withdrawal can affect cell and homeostatic functions on a variety of
levels," said Claudia Spies, medical associate director of the department of anesthesiology and intensive care medicine
at the University Hospital Charite Campus Mitte. "A chronic alcohol intake of at least 60g, or 1.5l beer, per day is associated
with severe complications such as higher rates of infections, cardiomyopathy, cardiac arrhythmias, bleeding complications
and liver insufficiency. During withdrawal, changes in electrolyte and water homeostasis occur. We know that the interaction
of different homeostatic systems is complex but the specifics are poorly understood."
The consequences, however, are clear. "The hospital stay of alcoholics is prolonged compared with that of non-alcoholics,"
said Spies. "A major complication is alcohol withdrawal syndrome (AWS), developed by approximately half of chronic alcoholics
during their hospital stay. The majority of the patients who develop AWS have hallucinations or delirium. AWS can also
be deadly. In one study, the mortality rate in patients with AWS was approximately 18 percent, whereas alcohol abusers
without AWS had a mortality rate of four to six percent, and non-alcohol abusers had a mortality rate of zero percent."
The study authors knew from previous research that various components of the physical and psychological stress-response
systems can sustain damage despite many months of abstinence. "Vasopressin, or AVP, is a hormone that is also part of
the stress regulatory system," said Ehrenreich. "In previous work, we showed that circulating levels of AVP are persistently
suppressed in alcoholic patients over many weeks of abstinence. This is why we chose to further elucidate the recovery
of vasopressin levels in alcoholics during long-term abstinence. Since atrial natriuretic peptide, or ANP, as well as aldosterone
and angiotensin II are counter-regulatory or counterbalancing hormones to AVP, it was logical to simultaneously follow
these parameters of water/electrolyte homeostasis."
Two groups of males participated in this study: alcoholics (n=35), 30 to 61years of age; and controls (n=20), 25 to
50 years of age. The two groups were matched on cigarette use. "It is well known that acute nicotine increases the secretion
of AVP," explained Ehrenreich. "It has to be assumed that chronic cigarette consumption also alters AVP secretion or metabolism. Therefore,
we used cigarette-matched controls in order to exclude the influence of such an interfering variable."
Following an inpatient detoxification period of two to three weeks, 21 of the 35 alcoholics were successfully monitored
for the full length of the study period, 280 days. Researchers collected data from all of the participants on their
AVP, ANP, aldosterone, and angiotensin II levels, as well as measures of kidney and liver function.
They found that basal AVP levels were suppressed during the entire study period. In contrast, ANP levels were elevated
for the entire time. No persistent alterations were found for aldosterone or angiotensin II.
"We learned that we are dealing with profound, long-lasting alterations of key hormones of water and electrolyte balance
notwithstanding at least nine months of controlled abstinence," said Ehrenreich. "These observations imply a number
of causes and consequences: they may explain excessive thirst and fluid intake, what we call diabetes insipidus; may explain
how alcohol-related cardiomyopathy develops; and may show that there is a subclinically impaired renal function in these
patients which clearly underlines the concept of multi-organ involvement in alcoholism, that is, not only are the liver
and brain affected, but basically all organs are."
Both Ehrenreich and Spies believe these results can be used to develop new therapeutic options to support abstinence
in alcoholics.
"One possibility would be to substitute AVP," said Ehrenreich, "which might not only contribute to recovery of water
and electrolyte homeostasis but also benefit cognitive functions such as memory. The findings of the present study imply
that at least some features of craving, such as drinking behaviour and thirst, might be explained by biological alterations
in the regulation of salt and water homeostasis. Therefore, approaches to substitute for vasopressin, or to normalize
vasopressin regulation, might result in a reduction of craving-induced relapses."
Ehrenreich added that one of the most important findings of this study is that "chronic alcoholism is associated with
long-term persistent alterations of various organs and systems even with controlled abstinence. There is no immediate
recovery to be expected," she stressed.
"Both for psychological as well as medical reasons, we need to consider that we are dealing with individuals severely
compromised over many months of controlled abstinence. Detoxification treatments are important and necessary to overcome
life-threatening withdrawal symptoms, but with respect to organic and psychological alterations in this group of patients,
they only reach the tip of the iceberg."
Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism
and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper included: Wolf K.H.
Doering, Marie-Noelle Herzenstiel, Henning Krampe, Henriette Jahn, and Sonja Sieg of the Departments of Psychiatry and
Neurology at Georg-August-University, and of Max-Planck-Institute for Experimental Medicine in Goettingen, Germany;
Lars Pralle of the Department of Medical Statistics at Georg-August-University; Elisabeth Wegerle of the Department of
Clinical Pharmacology at Georg-August-University; and Wolfgang Poser of the Departments of Psychiatry, Neurology, and Clinical
Pharmacology at Georg-August-University. The study was funded by the Max-Planck-Society.
Study Finds No Sign That Testing Deters Students' Drug Use May 17, 2003 By GREG WINTER - - NY Times Drug
testing in schools does not deter student drug use any more than doing no screening at all, the first large-scale national
study on the subject has found.
The United States Supreme Court has twice empowered schools to test for drugs - first among student athletes in 1995, then
for those in other extracurricular activities last year. Both times, it cited the role that screening plays in combating
substance abuse as a rationale for impinging on whatever privacy rights students might have.
But the new federally financed study of 76,000 students nationwide, by far the largest to date, found that drug use is
just as common in schools with testing as in those without it.
"It suggests that there really isn't an impact from drug testing as practiced," Dr. Lloyd D. Johnston, a study researcher
from the University of Michigan, said. "It's the kind of intervention that doesn't win the hearts and minds of children.
I don't think it brings about any constructive changes in their attitudes about drugs or their belief in the dangers
associated with using them."
The prevalence of drug use in schools that tested for drugs and those that did not was so similar that it surprised
the researchers, who have been paid by the government to track student behavior for nearly 30 years and whose data on
drug use is considered highly reliable.
The study, published last month in The Journal of School Health, a peer-reviewed publication of the American School Health
Association, found that 37 percent of 12th graders in schools that tested for drugs said they had smoked marijuana in
the last year, compared with 36 percent in schools that did not. In a universe of tens of thousands of students, such
a slight deviation is statistically insignificant, and it means the results are essentially identical, the researchers
said.
Similarly, 21 percent of 12th graders in schools with testing said they had used other illicit drugs like cocaine or
heroin in the last year, while 19 percent of their counterparts in schools without screening said they had done so.
The same pattern held for every other drug and grade level. Whether looking at marijuana or harder drugs like cocaine and
heroin, or middle school pupils compared with high school students, the fact that their schools tested for drugs showed
no signs of slowing their drug use.
While it is possible that schools that imposed screening had had even higher rates of use before, the researchers said
that was extremely unlikely because they controlled for behavioral factors normally associated with substance abuse
like truancy and parental absence.
"Obviously, the justices did not have the benefit of this study," said Graham Boyd, a lawyer for the American Civil Liberties
Union who argued the case against drug testing before the Supreme Court last year. "Now there should be no reason for
a school to impose an intrusive or even insulting drug test when it's not going to do anything about student drug use."
But other researchers contend that the urinalysis conducted by schools is so faulty, the supervision so lax and the opportunities
for cheating so plentiful that the study may prove only that schools do a poor job of testing.
"That's like blaming antibiotics if you didn't take them properly, or blaming the doctor who prescribed them," said Dr.
Linn Goldberg, a professor of medicine at Oregon Health and Science University, who conducted a much more limited study
on two Oregon high schools last year. It found that intensive, Olympic-grade testing could reduce drug use.
Still, Dr. Goldberg argued, even his study did not prove that testing limits consumption. "Schools should not implement
a drug testing program until they're proven to work," he added. "They're too expensive. It's like having experimental
surgery that's never been shown to work."
Most schools have shied away from drug testing. The Michigan study found that only 18 percent of the nation's schools
did any kind of screening from 1998 to 2001, most of them high schools. While a broad swath of the school population
may be screened, from honor students in extracurricular activities to students on probation, most of the testing focuses
on those who are suspected of using drugs.
Such tests do not violate the Fourth Amendment safeguards against unreasonable searches and seizures, the Supreme Court
has ruled, because children have limited expectations of privacy, the tests are not overly intrusive and because they
are likely to deter substance abuse. Writing for the court in 1995, Justice Antonin Scalia described the "efficacy of
this means for addressing the problem" of student drug use as "self-evident."
Seven years later, Justice Clarence Thomas restated the court's opinion, ruling that "the need to prevent and deter the
substantial harm of childhood drug use provides the necessary immediacy for a school testing policy."
Though the study may call those presumptions into question, it does not mean that drug testing is any less constitutional,
said the National School Boards Association, which filed legal briefs in support of testing to the court. Given the
other constitutional grounds for testing elaborated by the justices, particularly the role of schools as guardians of
their students' well-being, the association maintains that schools should continue to test, if they so choose.
"I'm not saying school districts should ignore that study," Naomi Gittins, an association lawyer, said. "I think it's
a good idea that schools take a look at that study. It's an important decision that they're making."
The study would not have swayed Randall Aultman, former principal of tiny Vernonia High School in Oregon whose decision
to screen its athletes led to the Supreme Court's 1995 ruling. Drug use was so rampant among his students that he says
"we had to do something drastic," without even knowing whether it was legal, much less effective.
"I don't think that drug testing works all the time, in all situations," Mr. Aultman said. "And the truth is there
were many kids who said, `Yeah, we quit while we were in season and once the season was over we went back to using drugs.'"
Even so, Mr. Aultman added, other students quit for life, and "at that time, it really worked." The Michigan study
was financed by grants from the National Institute on Drug Abuse, part of the National Institutes of Health, as well
as the Robert Wood Johnson Foundation, which supports drug testing in schools. It collected data on testing policies
at 722 middle and high schools, and drew on anonymous surveys from 30,000 8th graders, 23,000 10th graders and 23,000
12th graders, an enormous statistical undertaking that may not be matched for years. The researchers assume that some
will lie about their drug use, but say that the effects are insignificant.
There is at least one important limitation of the Michigan study. It does not differentiate between schools that do intensive,
regular random screening and those that test only occasionally. As a result, it does not rule out the possibility that
the most vigilant schools do a better job of curbing drug use.
"One could imagine situations where drug testing could be effective, if you impose it in a sufficiently draconian manner
- that is, testing most kids and doing it frequently," Dr. Johnston, the Michigan researcher, said. "We're not in a
position to say that wouldn't work."
The Supreme Court, however, has not ruled on whether testing all students, even those not in extracurricular activities,
is constitutional.
The National Institute on Drug Abuse said it would take several more such studies before any certainty about the efficacy
of testing can be established. More research is being explored, it said, but the results are probably years away.
Even so, some took the study as proof that education is the most effective weapon against substance abuse. They said that
while screening may give rise to a culture of resistance, in which students take pride in beating the test, the best
results come from convincing children that most children do not use drugs, making drugs less appealing.
"At best, testing could be a band-aid, and certainly not an answer," Tom Hedrick, director and founding member of
the Partnership for a Drug-Free America, said.
Jeffron Boynes Research Editor University of Illinois at Chicago (312) 413-8702; jboynes@uic.eduResearchers at the University of Illinois at Chicago's Jane Addams College of Social Work will use a $1.9 million grant
to study the impact of drugs and the justice system on women and their children.
The grant, from the National Institute on Drug Abuse, will support a five-year pilot project of research and teaching.
"Women who have families are being locked up or losing custody of their children, and the social costs have yet to
be calculated," said Larry Bennett, the study's principal investigator. "We want to look at the effects, not only of
drugs, but of the criminal justice response to drugs, and what that means for children and families of women."
Statistics show that: * Nearly 80 percent of female prisoners in the United States have a history of drug abuse *
Two-thirds of incarcerated women in the U.S. have dependent children * One in every 129 adult women is on probation or
parole (Source Greenfeld & Snell, 1999, "Women Offenders") During the project, UIC faculty will work with senior
substance-abuse researchers. They envision building a substance-abuse research program centered at the Jane Addams college.
Headed by Bennett, the researchers will conduct three pilot studies to determine what will help women successfully
leave prison, avoid returning to prison or drugs, and take care of their children once they're released.
The first study will investigate the impact of social services on substance-abusing mothers who have lost custody
of their children. The second study will examine the social service, employment, housing and drug treatment needs of
female ex-inmates in North Lawndale -- a neighborhood with a large number of female ex-offenders. The third study will
look at the influence of HIV on caregivers of children whose mothers have a history of substance abuse and are currently
in the criminal justice system.
Called the Jane Addams Substance Abuse Research Collaboration, the project will build on the college's tradition of
academic and community collaboration, says Bennett, a social work professor. It's a joint effort involving the college
and researchers in other UIC units, including the School of Public Health and departments of criminal justice, psychiatry,
urban planning and public administration.
UIC will also work with Loyola University's criminal justice department and with a number of social service agencies,
including TASC (Treatment Alternatives for Safe Communities).
The grant will pay for a minority research fellowship, an advisory board of senior research associates, and for substance-abuse
research seminars and conferences. UIC is one of six social work programs nationwide picked to receive the grant.
In addition to its substance-abuse research, the Jane Addams College of Social Work serves as home to the Great Lakes
Addiction Technology Transfer Center; the Midwest AIDS Training and Education Center; the Midwest Latino Health, Research,
Training, and Policy Center; the Kinship Care Practice Project; and the Jane Addams Center for Social Policy and Research.
NIH/National Institute on Drug Abuse Starting marijuana use during teens may result in cognitive impairment
later in life There is evidence that individuals who start to smoke marijuana at an early age--while the brain is still
developing--show greater cognitive deficits than do individuals who begin use of the drug when they are older, but the
reasons for this difference are unclear.
Scientists from the Harvard Medical School and from the intramural research program of the National Institute on Drug
Abuse (NIDA) found lasting cognitive deficits in those who started to smoke marijuana before age 17. The researchers
analyzed neuropsychological test results from 122 long-term heavy users of marijuana and 87 subjects who had used marijuana
only a few times (control subjects). Sixty-nine of the 122 users started using marijuana at age 17 or before. The subjects
were between the ages of 30 and 55 at the time of the study, and all had refrained from any drug use 28 days prior to
testing.
Individuals who started using marijuana at age 17 or younger performed significantly worse on the tests assessing
verbal functions such as verbal IQ and memory of word lists than did those who started using marijuana later in life
or who had used the drug sparingly. There were virtually no differences in test results among the individuals who started
marijuana use after age 17 and the control subjects.
The investigators suggest three possible hypotheses that might explain these differences. One possibility is that
early-onset smokers had lower innate cognitive skills before they ever started smoking marijuana. A second possibility
is poor learning of certain cognitive skills by young users of marijuana who neglect school and academic pursuits. The
third and most ominous possibility is that marijuana itself has a neurotoxic effect on the developing brain. According
to the authors, further research will be required to determine the relative contributions of these three factors.
WHAT IT MEANS: Youth who use marijuana before their midteens may show long-term deficits in certain verbal skills--but
the reasons for these deficits are not yet clear.
Dr. Harrison Pope and colleagues published the study in the March 2003 issue of the journal Drug and Alcohol Dependence
Cannabis 'link to schizophrenia rise' Softer drugs law blamed for risk of mental illness as users aim to get heavily
'stoned' Jo Revill, health editor Sunday April 6, 2003 The Observer < http://www.observer.co.uk/politics/story/0,6903,930585,00.html> Stronger cannabis - and users getting stoned to a 'far more debilitating degree' - could lead to a rise in cases
of schizophrenia and present the NHS with a much larger bill, a leading drugs expert will warn tomorrow.
Professor John Henry believes that the Government, in its decision to relax the laws on cannabis, has overlooked
the burden that greater use puts on health services and on families - as well as the way young people are seeking to
heighten the effects of the drug.
Henry, a toxicologist and professor of accident and emergency medicine at Imperial College London, will talk about
the medical risks associated with the drug at a conference tomorrow. He fears that several hundred more young people
could end up in hospital suffering from schizophrenia, and might need anti-psychotic drugs to deal with their condition.
A year ago the Government announced plans to reduce the classification of cannabis from category B to C, after a
recommendation from the Police Federation that it was far less harmful than other drugs. The reclassification takes
place this summer, and anyone caught smoking a joint will be much less likely to be arrested or prosecuted for possession.
The policy change follows a controversial scheme in Lambeth, south London, in which the Metropolitan Police decided
to focus on hard drug users rather than cannabis smokers. The Met said it achieved great results against hard drug dealers,
but some health workers were worried that children in the area felt it was now legal - and safe - to smoke cannabis.
There is mounting concern among psychiatrists about the future impact of the softening of the law. Three million
people are thought to smoke cannabis regularly, a quarter of them young adults under the age of 29. It has been shown
that more people are growing cannabis for their own consumption.
Some doctors have argued that cannabis can be highly beneficial for patients suffering chronic pain, or those with
multiple sclerosis.
However, Henry will warn at the Royal Society of Medicine's conference that there has been a recent, dangerous shift
in the way people use cannabis and alcohol.
Recreational use has given way to a cultural acceptance of getting stoned regularly to a 'far more debilitating degree',
according to Henry. 'Modern cannabis is nearly 10 times the strength the "flower power" generation was used to, and
in Amsterdam it is at least twice as strong as in the UK,' he said. 'We know that for those who take the drug there is
a fourfold increase in schizophrenia and a fourfold increase in the chances of suffering major depressive illness.
Given that we know schizophrenia accounts for some 3 per cent of the total NHS bill, the costs could go up by another
1 per cent. That should be urgently considered by the Government.'
Henry believes there are emerging mental health problems associated with THC, or tetrahydrocannabinol, the main active
ingredient of cannabis, which in greater concentrations makes more potent forms of the drug, such as 'skunk'.
To investigate its effects on the brain, a study is about to begin at the Maudsley Hospital in south London. Volunteers
will be offered free cannabis, so that researchers can carry out brain scans and conduct memory tests to see how mental
activity is affected.
Professor Robin Murray, who is leading the study, said his view of the drug had changed in recent years. He used
to be sceptical when cannabis was blamed. 'Relatives would say "It seems to be the cannabis that makes my son or daughter
or brother psychotic" and I would say, "Oh, they're being hysterical, they're just trying to look for something to blame".
We've come to realise that it does have a significant effect, but it has taken us a long time to wake up to this.'
Others, however, point to the fact that rates of schizophrenia have not risen dramatically in the past 50 years to
correspond with increasing use of the drug. There is also a question over whether those who are likely to develop schizophrenia
are already predisposed to take cannabis.
Recent guidance on the provision of drugs for schizophrenia by the National Institute for Clinical Excellence (Nice)
estimated that treatment of schizophrenia in England and Wales was responsible for around 3 per cent of the entire
NHS budget - some £1 billion a year.
Cliff Prior, chief executive of Rethink, a charity helping those with mental illness, said: 'The public needs to
understand that this danger is real. There is growing evidence that cannabis may trigger schizophrenia in vulnerable
people.'
Study quantifies cost-benefit of family interventions to prevent teen alcohol use Designed to prevent adolescent
alcohol use Iowa State University researchers have calculated that brief family intervention programs designed to discourage
teen drinking are both beneficial and cost-effective. Their study found that each dollar spent on intervention programs
for adolescents was returned many times over in savings by preventing future costs associated with alcohol problems in
adulthood.
The research, published in the Journal of Studies on Alcohol, was funded by NIDA and the National Institute of Mental
Health.
Acting NIDA Director Dr. Glen R. Hanson says, "This study demonstrates that investing dollars in preventive intervention programs
is not only a good public health practice, but it is a good economic practice as well. The personal and public health benefits
of preventing teen drinking and adult alcohol abuse are well known. Less well known by the public are the costs of these
problems."
According to the latest statistics from the National Institute on Alcohol Abuse and Alcoholism, the annual economic
costs of alcohol abuse in 1998 were estimated to be $185 billion.
The Iowa investigators based their cost-benefit calculations on data from a longitudinal prevention trial with families
of sixth graders from 33 rural schools in a Midwestern state. The families were randomly assigned to one of two interventions
or to a control group. The two interventions were the Iowa Strengthening Families Program (ISFP), a seven-session intervention
with parents and students together, and Preparing for the Drug Free Years (PDFY), a five-session intervention primarily
involving parents.
The researchers conservatively estimated that prevention of a single case of adult alcohol abuse produces an average
savings of $119,633 in avoided costs to society. Factoring these savings into the costs and effectiveness of the two
interventions revealed that the ISFP intervention saved $9.60 in future costs for each dollar invested, and that the
PDFY intervention yielded a benefit-cost ratio of $5.85 for each dollar invested.
The premise behind each intervention was similar: to focus on intervention during the critical period of transition
in early adolescence, to promote parent-child bonding, to encourage effective family functioning, and to strengthen
the child's defenses against negative peer influences, such as increasing the skills in resisting peer pressure to use
alcohol.
Analyses were based upon 478 families at the end of the four-year study. One hundred sixty-two families were in the
ISFP group, 153 in the PDFY group, and 163 in the control condition.
Between the critical ages of 13 and 16, fewer adolescents in the two treatment groups started to use alcohol compared
to those in the control group. Based on study analyses, it would then be expected that fewer of the teens in the two
intervention groups would be expected to develop problems with alcohol use as adults.
Lead investigator Dr. Richard L. Spoth says, "Family skills-training interventions designed for general populations
have the potential to delay the onset of alcohol use, thereby avoiding the substantial costs to society at a proportionally
small intervention cost."
Program Tries to Get Mentally Ill Off Streets Wed Aug 7,12:39 PM ET By Alan Elsner, National Correspondent NEW
YORK (Reuters) - They are a common sight on the streets of every American city -- unkempt men and women pushing supermarket
carts piled high with belongings, muttering to themselves, pestering passersby for money and occasionally making wild
gestures.
Studies estimate that up to 200,000 people suffering from severe mental illnesses are homeless in the United States
at any given time. Tens of thousands are military veterans.
Despite a substantial increase in programs designed to help in the past 10 years, nothing seems to make a dent in
the numbers.
"We started doing outreach 10 or 15 years ago and we have learned that most of these people don't want to be living
on the streets and are willing to accept help and treatment if they are approached in the right way," said Deborah Dennis,
project manager for the National Resource Center for Homelessness and Mental Illness.
After several years of stable figures, and even slight declines in some places, homelessness seems to be rising again,
possibly spurred by the tough economy.
According to the Coalition for the Homeless, the number of homeless single adults in New York shelters has risen this
year to the highest levels since 1990s. City outreach workers, community groups and city officials also report a rise
in street homelessness, especially among the mentally ill.
The coalition said in April there were nearly 33,000 homeless adults and children sleeping each night in the municipal
shelter system -- the largest shelter population ever recorded in the city. The number jumped by more than 5,500 during
2001, the largest single-year increase since the Great Depression of the 1930s.
"We do know how to help and what works. The question is whether we are willing to commit the resources necessary to
tackle the problem," Dennis said.
Studies suggest men and women with illnesses like schizophrenia have at least a 25 percent chance of becoming homeless.
Once they lose the ability to hold down a full-time job, a shortage of affordable housing soon pushes many onto the
streets. And since a high proportion are also abusing drugs and alcohol, it is not easy to lure them into programs.
Alan Felix, a New York psychiatrist who has been working with the homeless for longer than 15 years, has developed
a program called Critical Time Intervention (CTI) that has shown promising results in helping such people.
Under the program each client is assigned a personal case manager for a critical nine-month period, during which they
move from the shelter back into the community into some form of subsidized group housing.
SHELTER WAS IN HOLLYWOOD MOVIE
A follow-up study found that people who went through the CTI program spent only a third as many nights on the streets
during the next nine months as a control group of homeless people who had not been offered special services. Similar
programs are now being launched in other cities including Los Angeles, Philadelphia, San Francisco and San Diego, as well
as among military veterans nationwide.
"Trying to make the transition from the shelter to the community on their own is too much for most people with severe
mental illness. The case manager helps them get over this hurdle," said Felix, who works out of the Fort Washington
shelter, a disused National Guard armory which was featured in a 1993 Hollywood film starring Matt Dillon and Danny Glover,
"The Saint of Fort Washington.
At that time, up to a thousand homeless men slept side by side in the shelter in a huge room, their beds lined up
in neat rows. Now, the shelter specializes in the mentally ill and houses only around 200 people. The vast hall has
been turned into a state-of-the-art indoors athletics track.
The case managers working with Felix try to ensure that their clients remain on medication and off drugs, help them
manage their money, solve crises that may occur, try to put them back in touch with their families and teach them necessary
life skills.
"We've had people who didn't know how to open the windows in their housing or how to use a microwave oven, simple
things like that which the rest of us take for granted," said Felix.
The problem with such programs is that they are labor intensive and can only handle a relatively small number of people
at any one time.
Nationally, a 1996 study found that an estimated 842,000 people were homeless in any given week and that 3.5 million
adults and children experienced some period of homelessness over the course of a year.
When they are not on the streets, large numbers of mentally sick people wind up in jail.
"Jails and prisons have become the final destination of the mentally ill in America. It's a huge problem. There are
more mentally ill folk in state prisons than in state hospitals," said University of Rochester psychiatrist Steve Lamberti,
who runs another program for the severely mentally ill.
"The Los Angeles County Jail has become the nation's largest mental institution," he said.
University of Pennsylvania researcher Dennis Culhane believes intervention programs to get the mentally ill off the
streets are highly cost effective.
His research in New York found that the cost of providing shelter, jail and hospital services for them came to an
average of $40,499 per person. Residents used $16,282 less in services after moving into supervised housing, with the
biggest drops in shelter use and jail time, which fell by 85 percent.
"A considerable amount of public dollars is spent essentially maintaining people in a state of homelessness," Culhane
said in a 2001 interview. "By putting those same dollars into supportive housing, the solution can pay for itself."
SOURCE: LifeSkills Training Study Finds That Three Most Popular Teen Drug Prevention Programs Have No Long-Term
Effect The Good News Is That Parents Need Not Despair NEW YORK, NY--(INTERNET WIRE)--Aug 13, 2002 -- The news is devastating
for parents who were hoping to pre-empt their kids' use of drugs with school or community-based prevention programs. But
the findings could be a blessing in disguise for communities that are committed to keeping their kids safe from drugs
and other risky behaviors.
The Associated Press reported on August 3rd that the three best known drug prevention programs for kids are "either
ineffective or haven't been sufficiently tested," and that despite "a decade of efforts from the federal government
to promote proven programs, many schools still use heavily marketed curricula that have not been evaluated, have been
evaluated inadequately or have been shown to be ineffective in reducing substance abuse."
The study's author also found that unbelievably, only 19 percent of schools reported using research-based programs,
commenting, "It's not a good use of taxpayers' money."
"This is actually good news for parents, because it finally brings to light the real reason that many well-intentioned
prevention efforts have failed," comments Gilbert J. Botvin, Ph.D. Professor of Public Health and Psychiatry at Weill
Medical College of Cornell University, and President, Society for Prevention Research.
Botvin points to the dramatic advances in prevention research, leading to the development of proven prevention programs
that arm kids with the solid social skills, drug refusal skills, and self-management skills needed to fend off the pressures
and social influences to smoke, drink, or use illicit drugs.
Thanks to advances in prevention science, we now have the tools available to keep our kids safe. Studies published
in top scientific journals show that the most powerful of these programs can cut tobacco, alcohol, and illicit drug
use by up to 60%. "Now that we know exactly what works and what doesn't work, the challenge is to help parents, educators
and communities to find programs that are proven to work and promote their widespread use," adds Dr. Botvin."
To identify a proven anti-drug program for your school, church, or community, check out the list of U.S. federal agencies
below.
Background on Dr. Gilbert J. Botvin and LifeSkills Training
Dr. Gilbert J. Botvin is founder of LifeSkills Training, widely regarded as the most effective and rigorously tested
school-based prevention program. The training works because it equips kids with the self-management tools they need
to effectively resist outside influences as early as middle school and even upper elementary age.
Proven to cut alcohol, tobacco and drug use by up to 87 percent, LifeSkills Training is based on 20 years of research
by Dr. Botvin and his associates at the Institute for Prevention Research of Cornell University Medical College. More
than a dozen published research studies have documented the effectiveness of the LST approach.
LifeSkills Training is the only substance abuse prevention program recommended by every key federal agency concerned
with substance abuse, including the National Institute on Drug Abuse, the Centers for Disease Control and Prevention,
the Center for Substance Abuse Prevention, the U.S. Department of Education, the U.S. Department of Justice, and the
White House Office of National Drug Control Policy. The program is currently in use in 7,500 classrooms and 3,000 schools/districts
throughout all 50 states, serving more than 1 million students, and worldwide in Japan, Korea, Mexico, Sweden, Hong Kong,
New Zealand and Argentina.
Federal Agencies' Lists of Effective Programs
The major federal agencies involved with substance use have all made recommendations to the field about programs that
have been repeatedly proven to work so they can be more thoroughly disseminated. These agencies include:
- Center for Substance Abuse Prevention (CSAP): "Model Programs" lists effective prevention programs ranging from
school-based curricula to those that involve large-scale environmental strategies such as anti-tobacco advertisements.
Go to: www.samhsa.gov/centers/csap/modelprograms.
- US Department of Justice (DOJ): "Promising Strategies" identifies prevention programs that have been proven to reduce
substance use and violence. Go to: www.ojp.usdoj.gov/docs/psrsa.pdf.
- National Institute on Drug Abuse (NIDA): "Preventing Drug Use Among Children and Adolescents: A Research-Based Guide"
enumerates some of the most outstanding and rigorously tested prevention programs and provides a resource for those
making choices about prevention needs. Go to: 165.112.78.65/pubs/preventpubs.taf?functions=form
Effectiveness of Integrated Services for Homeless Adults with Serious Mental Illness [.pdf] http://www.dmh.cahwnet.gov/WhatsNew/docs/AB2034-4-23.pdfAvailable to the Internet community from the California Department of Mental Health, this 55-page report to the Legislature
provides recent information on the Department of Mental Health's administration and implementation of programs at county
and city levels that serve homeless adults with serious mental illness in the state of California. Some of the report's
findings include a 66% decrease in hospitalization, a 82% decrease in the number of days incarcerated, a 79% decrease
in the number of days spent homeless, and a 169% increase in the number of days employed for the 305 Los Angeles County
participants. Available in Adobe Acrobat (.pdf) format, this report contains small fonts and maybe more easily readable
when printed. [MG] From The Scout Report, Copyright Internet Scout Project 1994-2002. http://scout.cs.wisc.edu/
Report: Millions Behind Bars in U.S. By JONATHAN D. SALANT Associated Press Writer August 25, 2002 WASHINGTON
(AP) – One in every 32 adults in the United States was behind bars or on probation or parole by the end of last year,
according to a government report Sunday that found a record 6.6 million people in the nation's correctional system. The
number of adults under supervision by the criminal justice system rose by 147,700, or 2.3 percent, between 2000 and 2001,
the Justice Department reported. In 1990, almost 4.4 million adults were incarcerated or being supervised. "The overall
figures suggest that we've come to rely on the criminal justice system as a way of responding to social problems in a way
that's unprecedented," said Marc Mauer, assistant director of the Sentencing Project, an advocacy and research group that
favors alternatives to incarceration. "We're setting a new record every day." Almost 4 million people were on probation,
2.8 percent more than in 2000, while the number of people in prison grew by 1.1 percent to 1.3 million, the smallest annual
increase in nearly three decades. More than half of those on probation – 53 percent – had been convicted of felonies,
according to the Bureau of Justice Statistics report. Experts noted the recent trend of arrests declined for murder, rape
and other violent crimes. Many of those on probation were convicted of using illegal drugs or driving while intoxicated, the
report showed. In addition, some states have eliminated mandatory minimum sentences for certain crimes. California's Proposition
36, passed in 2000 with 61 percent of the vote, requires treatment rather than incarceration for nonviolent drug offenders.
Most of those drug users wind up on probation. "The collection of reforms, from drug courts to treatment in lieu of incarceration
to sentence reforms like getting rid of mandatory minimums and expanding community correction options, have the effect of
redirecting people from prison to probation," said Nick Turner, director of national programs for the Vera Institute of Justice.
The nonprofit research group works with governments on criminal justice issues. The government report found that 46 percent
of those discharged from parole in 2001 had met the conditions of supervision, while 40 percent went back to jail or prison
for violations. Texas had more adults under correctional supervision than any other state, 755,100. California was second
with 704,900. Texas also had the most adults on probation, 443,684, followed by California at 350,768. Whites accounted
for 55 percent of those on probation, while blacks made up 31 percent, statistics show.
Report: Millions Behind Bars in U.S. By JONATHAN D. SALANT Associated Press Writer August 25, 2002 WASHINGTON
(AP) – One in every 32 adults in the United States was behind bars or on probation or parole by the end of last year,
according to a government report Sunday that found a record 6.6 million people in the nation's correctional system. The
number of adults under supervision by the criminal justice system rose by 147,700, or 2.3 percent, between 2000 and 2001,
the Justice Department reported. In 1990, almost 4.4 million adults were incarcerated or being supervised. "The overall
figures suggest that we've come to rely on the criminal justice system as a way of responding to social problems in a way
that's unprecedented," said Marc Mauer, assistant director of the Sentencing Project, an advocacy and research group that
favors alternatives to incarceration. "We're setting a new record every day." Almost 4 million people were on probation,
2.8 percent more than in 2000, while the number of people in prison grew by 1.1 percent to 1.3 million, the smallest annual
increase in nearly three decades. More than half of those on probation – 53 percent – had been convicted of felonies,
according to the Bureau of Justice Statistics report. Experts noted the recent trend of arrests declined for murder, rape
and other violent crimes. Many of those on probation were convicted of using illegal drugs or driving while intoxicated, the
report showed. In addition, some states have eliminated mandatory minimum sentences for certain crimes. California's Proposition
36, passed in 2000 with 61 percent of the vote, requires treatment rather than incarceration for nonviolent drug offenders.
Most of those drug users wind up on probation. "The collection of reforms, from drug courts to treatment in lieu of incarceration
to sentence reforms like getting rid of mandatory minimums and expanding community correction options, have the effect of
redirecting people from prison to probation," said Nick Turner, director of national programs for the Vera Institute of Justice.
The nonprofit research group works with governments on criminal justice issues. The government report found that 46 percent
of those discharged from parole in 2001 had met the conditions of supervision, while 40 percent went back to jail or prison
for violations. Texas had more adults under correctional supervision than any other state, 755,100. California was second
with 704,900. Texas also had the most adults on probation, 443,684, followed by California at 350,768. Whites accounted
for 55 percent of those on probation, while blacks made up 31 percent, statistics show. On the other hand, 46 percent of those
incarcerated were black and 36 percent were white.
Smoking pot alters more than mood --human immune system affected, USF/UCLA study finds Tampa, FL (Aug. 27, 2002)
- Marijuana may alter immune function in people - but the jury is still out on whether it hurts or helps the body's
ability to fight infection or other diseases, report researchers at the University of South Florida College of Medicine and
the UCLA School of Medicine in Los Angeles.
"The bottom line is you cannot routinely smoke marijuana without it affecting your immune system," said Thomas Klein,
PhD, professor of medical microbiology and immunology at USF. "However, because of the complexity of the immune system,
we can't say yet whether the effect we've observed in humans is good or bad."
A study by USF and UCLA is the first to show that healthy humans who smoke marijuana appear to alter the expression
of marijuana receptors, or molecules, on immune cells in their blood. The findings were reported in the June issue of
the Journal of Neuroimmunology.
Pot's influence on the immune system continues to be hotly debated. While more human studies are needed, overwhelming
evidence from animal studies indicates that marijuana and its psychoactive compounds, known as cannabinoids, suppress
immune function and inflammation.
"This suggests marijuana or cannabinoids might benefit someone with chronic inflammatory disease, but not someone
who has a chronic infectious disease such as HIV infection," said Dr. Klein, lead investigator of the study.
The USF/UCLA group is one of few in the world conducting studies to define the role of cannabinoid receptors in regulating
immunity in both drug abusers and nonusers.
If the results in animals hold true in humans, their work might lead to the development of safe and effective cannabinoid
drugs for certain diseases, Dr. Klein said. "If the cannabinoids in marijuana are effective immune suppressors, this
property might be harnessed to treat patients with overly aggressive immune responses or inflammatory diseases like
multiple sclerosis and rheumatoid arthritis."
Receptors that react to delta-9 tetrahydrocannabinol or THC, the compound in marijuana that produces a high, have
been found in tissues throughout the body and in the brain. A naturally circulating THC-like substance called anandamide
also binds to and activates these marijuana, or cannabinoid, receptors, indicating that the body's own cannabinoid system
plays a physiological role in normal immunity as well as defining moods, Dr. Klein said.
In the USF/UCLA study, researchers analyzed blood samples from 56 healthy volunteers - including 10 chronic marijuana
smokers, ages 22 to 46, participating in lung and immune function studies at UCLA. The marijuana smokers denied use
of any other drugs, and the nonsmokers denied all illegal drug use.
Because no accurate way yet exists to directly study the expression of cannabinoid receptors on immune cells, the
researchers looked at the genetic material (messenger RNA) that is the direct predecessor, or precursor, of the receptor.
They found that the baseline genetic expression of this precursor RNA was consistent across all age, gender and ethnic
groups. But, the peripheral blood cells from the marijuana users expressed significantly higher levels of cannabinoid
receptor messenger RNA than blood cells from non-users. The levels increased regardless of the amount of marijuana use,
although all users in the study had a history of smoking pot several times or more a week.
Ill Americans Seek Marijuana's Relief in Canada September 8, 2002 By CLIFFORD KRAUSS - - NY Times VANCOUVER,
British Columbia - Four decades ago, a wave of American draft dodgers fled to Canada rather than fight in Vietnam. Some turned
to planting marijuana seeds to make a living and spurred an underground industry that is now booming across British Columbia.
Over the last year or so, a new generation of Americans has flocked into western Canada, fleeing the Bush administration's
crackdown on the clubs that say they provide marijuana to sick people, particularly in California.
A handful who face drug charges and convictions in the United States have applied for political asylum. Hundreds more
American marijuana smokers live underground existences here, local marijuana advocates say.
Canada is in the awkward position in which it either must stand up to the United States - and encourage more refugees
and asylum applications - or evict people who say they suffer from cancer and other deadly diseases.
While general use of marijuana is illegal in both countries, Canada has been far more tolerant of its use for medical
purposes.
"It's an exodus," said Renee Boje, 32, a California fugitive from drug charges who has applied for refugee status.
"Canada has a history of protecting the American people from its own government like during the Vietnam War, and the
Underground Railroad that protected American runaway slaves."
Most of the Americans here do not face charges at home, marijuana advocates say, but came because they can get the
drug more cheaply and easily here now since the American clubs were shut down. "Compassion clubs" thrive in several
Canadian communities to serve what they say are the medical needs of severe pain sufferers.
"In the last year the number of Americans coming and intending to stay has skyrocketed," said Marc Emery, president
of the B. C. Marijuana Party, who provides legal aid to the Americans. He estimated that the number of recent arrivals
was "in the hundreds."
Some of them work on farms, living a countercultural life not very different from that of the previous generation
of American refugees. Others are living on the street, or moving from couch to couch in homes of Canadian marijuana
users. Some have gone into businesses like herbal medicine stores or work in marijuana cultivation.
To Bush administration officials, the American fugitives are simply lawbreakers.
"It's regrettable that people who are charged with criminal offenses in the United States don't face justice here
and put a burden on another country," said John Walters, President Bush's drug policy chief.
He said that there was no evidence that smoking marijuana was an effective medicine, and that the agenda of many who
argue for medicinal marijuana is to legalize drugs.
Attorney General John Ashcroft and the Drug Enforcement Administration director, Asa Hutchinson, have stiffened enforcement against
marijuana clubs that had grown around California after an initiative called Proposition 215 passed in 1996, making marijuana legal
for treating some sick people. Asserting the superiority of federal antidrug laws, federal agencies have raided some clubs,
and others have closed or gone underground.
Steven W. Tuck, a 35-year-old disabled veteran of the Army, fled to Canada pretending he was going fishing after his
club was repeatedly raided and he faced drug charges. He was arrested for overstaying his visa and, fearing deportation,
applied for refugee status.
Sitting recently in Vancouver's Amsterdam Cafe, where smoking marijuana is allowed, he was sweating and shaking awaiting
a friend who had gone out to buy some. "I have to have marijuana to stay alive," said Mr. Tuck, who said his torment
began in 1987 with an Army parachuting accident that caused spinal and brain injuries.
If he is sent home and denied marijuana, Mr. Tuck says, he fears he will die "choking on my vomit in jail."
The Canadian Justice Ministry will not discuss refugee cases. To grant asylum, Canada would have to determine that
the Americans would face unwarranted persecution at home.
The cases come at a time when the cabinet and Parliament are discussing whether to decriminalize marijuana, with many
Canadians arguing that American attitudes are overly restrictive. [On Sept. 4, a Canadian Senate committee recommended
that the country legalize marijuana use for people over 16.
There is also a cabinet debate over whether the government should provide marijuana to chronically ill Canadians or
conduct clinical trials first.
"We can't base our policy on social issues like this on American standards, especially in an area where they're very
conservative," said Industry Minister Allan Rock, a former health minister who believes that chronically ill patients
should have access to quality-controlled marijuana.
The most prominent American fugitive here is Steve Kubby, 55, the Libertarian Party candidate for governor of California
in 1998. He and his wife, Michele, have an Internet news program on marijuana issues.
They fled California last year for the rural British Columbia town of Sechelt after the police found 265 marijuana
plants, a mushroom stem and some peyote buttons in their house. Mr. Kubby had been sentenced to four months of house
arrest and three months of probation, which he feared might eventually lead to a prison term in which he would be denied
the marijuana that he says he needs to treat his adrenal cancer.
"If I don't smoke pot," he said, "my blood pressure goes through the roof and would either burst a blood vessel or
cause a heart attack."
He appealed his sentence, then brought his family to Canada. He was arrested here, and he could be deported.
Meanwhile, he applied for permission to cultivate and possess marijuana for his own medical use. He provided Canadian
authorities with a letter from a University of British Columbia doctor who substantiated his need "to continue to use
cannabis to control the symptoms caused by his disease."
The government recently granted him the right to grow and possess a limited amount for a year, which advocates viewed
as a major victory.
"It's threatening to the whole ideology of prohibition," Mr. Kubby said, "which says any marijuana use is criminal."
More Americans used illegal drugs in 2001, U.S. study says Fri Sep 6, 8:55 AM ET Svetlana Kolchik USA TODAY Nearly
2 million more Americans used illicit drugs in 2001 than in 2000, according to a major government survey released Thursday.
Experts say reasons range from stress after Sept. 11 to the shaky economy to an atmosphere more accepting of marijuana
use.
In 2001, an estimated 7.1% of the U.S. population, or 15.9 million people, identified themselves as current drug users.
In 2000 and 1999, about 6.3%, or 14 million, said they were drug users.
The National Household Survey on Drug Abuse, a survey of 70,000 people conducted by the Department of Health and Human
Services is the largest study of drug use in America. Other findings: * The percentage of Americans age 12 and older
who consume alcohol occasionally (at least one drink in the past month) rose from 46.6% in 2000 to 48.3% in 2001.
* The rates of drug use among younger people rose significantly. In 2000, 9.7% of teenagers and 15.9% of young adults
18-25 said they used a drug in the month before the survey, vs. 10.8% of teens and 18.8% of young adults in 2001.
* Marijuana, Ecstasy, pain relievers, tranquilizers and other non-prescribed psychotherapeutic drugs remain the most
popular. As many as 2.4 million Americans used marijuana for the first time in 2000, 1 million more than in 1990, the
survey estimated.
John Walters, director of the White House Office of National Drug Control Policy and an opponent of relaxing drug
laws, says the growing social acceptance of marijuana may have contributed to its popularity. Proposals to decriminalize
marijuana possession send the wrong message, he says.
But others say it's the taboo factor that entices people, especially youngsters, to try marijuana.
''The 'forbidden fruit' phenomenon is a very strong motivator,'' says Mitchell Earlywine, who teaches about drugs
at the University of Southern California.
Glen Hanson, director of the National Institute on Drug Abuse, cites post-Sept. 11 stress and concern over the economy
as factors. ''We are under a lot of stress in this country now,'' he says. ''Drugs stimulate the pleasure center,''
and people may be using drugs to cope with problems.
About 16.6 million Americans are dependent on drugs or alcohol, the survey says; 2.4 million are dependent on both.
UF study: Marriage can reduce life of crime GAINESVILLE, Fla. --- The bliss of a steady marriage is a strong antidote
to a life of crime, a new University of Florida study finds. In a study of paroled men, the UF research team found that
the most hardened ex-cons were far less likely to return to their crooked ways if they settled down into the routines
of a solid marriage, said Alex Piquero, a UF professor of criminology and law who led the study.
This tendency to stay on the straight and narrow was common among whites, blacks and Hispanics, according to the study
published in the September issue of the journal Social Science Quarterly.
"People who are married often have schedules where they work 9-to-5 jobs, come home for dinner, take care of children
if they have them, watch television, go to bed and repeat that cycle over and over again," Piquero said. "People who
are not married have a lot of free rein to do a lot of what they want, especially if they are not employed."
There is a twist. Common-law marriages or living with a partner did not have the same crime-reducing effect as did
traditional marriages in which the knot is tied, the union is registered at the courthouse, and there is a general expectation
to lead a steady life.
In fact, the study found that cohabiting without marriage actually increased the likelihood that parolees would recommit
crimes, at least among parolees who are not Caucasian.
"Nonwhites, especially African-Americans, have lower rates of marriages than whites, and it could be, especially among
male criminal offenders, that the idea of marriage is a foreign concept to them, perhaps because they may have come
from single-parent families or are surrounded by single-parent households," he said.
Statistics indicate many nonwhite parolees are not steadily employed, so women may not look upon them as desirable
marriage partners anyway, Piquero said. Rather than entering relationships with partners who might stymie their involvement
in crime, ex-cons end up sticking with women who allow them to continue their errant ways, he said.
"There's something about crossing the line of getting married that helps these men stay away from crime," he said.
"If they don't cross that line, they can continue their lifestyles, which are pretty erratic."
Using arrest records from the state of California, Piquero, Karen Parker, also a UF criminology and law professor,
and John MacDonald, a University of South Carolina criminal justice professor, tracked each of 524 men in their late
teens and early 20s for a seven-year period after they were paroled from the California Youth Authority during the 1970s
and 1980s. The sample of men, who had been incarcerated for lengthy periods of time, was 48.5 percent white, 33 percent
black, 16.6 percent Hispanic and 1.9 percent other races. The study, funded by the National Institute of Justice, sought
to identify factors leading to continued involvement in crime, as well as those relating to crime reduction, Piquero
said. It examined alcohol and drug use, marriage and employment.
The only other factor to influence recidivism was heroin dependency, Piquero said. Parolees who abused heroin became
involved in a wide range of violent and nonviolent crimes, he said.
Piquero said he was surprised by the results.
As the state's last stop for criminal offenders, the California Youth Authority draws the worst criminal offenders.
"These aren't one-time offenders who are selling a few joints out on the street," he said. "I honestly didn't expect
to find the 'marriage effect' among these people, because they had made lots of bad choices in their lives prior to
this point and had long, long rap sheets," he said.
The results also may apply to criminals across the country because research has shown many crime-related factors are
similar nationally and even internationally, Piquero said. "Serious offenders in California are not that much different
from serious offenders in Florida, New Jersey or New York," he said.
The findings underscore the importance of life circumstances over time, Piquero said. "It shows that life events such
as marriage matter and can trigger changes from one pathway to another, causing a move in a different direction," he
said.
Recreational use of the drug 'Ecstasy' causes new kind of brain damage Researchers at Johns Hopkins have found
that doses of the popular recreational drug "Ecstasy" similar to those that young adults typically take during all-night
dance parties cause extensive damage to brain dopamine neurons in nonhuman primates. Brain dopamine cells help control
movement, emotional and cognitive responses, and the ability to feel pleasure, according to the study, published in the September
27 issue of Science. The findings may also shed light on the mechanisms by which Ecstasy damages brain cells.
"The most troubling implication of our findings is that young adults using Ecstasy may be increasing their risk for
developing parkinsonism, a condition similar to Parkinson's disease, as they get older," said George A. Ricaurte, M.D.,
associate professor of neurology at The Johns Hopkins University School of Medicine and lead author of the study.
Parkinsonism occurs when brain dopamine neurons are damaged beyond a certain threshold, resulting in a 90 percent
or greater loss of brain dopamine, Ricaurte explained. The new findings raise concern that if Ecstasy damages brain
dopamine neurons in humans, as it does in monkeys, parkinsonism could develop years after taking the drug because brain
dopamine declines with advancing age, said Ricaurte.
"The lack of obvious immediate harmful effects of Ecstasy is partly responsible for the widely held belief that the
drug is safe," said Ricaurte. "But people should be aware that the use of Ecstasy in doses similar to those used in
recreational settings can damage brain cells, and this damage can have serious effects."
Ricaurte added that the patterns of Ecstasy use have changed since the 1980s when the drug was taken primarily on
college campuses, and individuals typically took one or two doses twice monthly. More recently, many individuals take
several sequential doses of the drug over the course of a single night. The new study was part of ongoing efforts to
further evaluate the neurotoxic risks posed by Ecstasy to humans, said Ricaurte.
To measure the adverse effects of Ecstasy, also known as MDMA or 3,4-methylene-dioxymethamphetamine, the researchers
gave squirrel monkeys three sequential doses of Ecstasy at three-hour intervals. Following this regimen, which is similar
to that used by recreational Ecstasy users at all-night parties, they found that in addition to serotonin deficits,
which the drug has been known to cause for some time, the monkeys unexpectedly developed severe, long-lasting brain dopamine
deficits.
Then, using a variety of techniques to look at a region of the brain called the striatum, they found that 60 percent
to 80 percent of the dopaminergic nerve endings were destroyed. To determine if these results were unique to squirrel
monkeys, the researchers performed the experiments again, this time with baboons, and obtained similar findings of neuronal
injury.
"We do not yet know if our findings in nonhuman primates will generalize to human beings but, needless to say, this
is a major concern," said Ricaurte.
"The message seems clear," added Ricaurte. "The neurotoxic potential of MDMA is high, and use of several sequential
recreational doses could have serious, long-term consequences."
Glen R. Hanson, Ph.D., D.D.S., acting director of the National Institute on Drug Abuse, adds, "This study underscores
the need for more research about the extent and nature of the damage that Ecstasy may cause. Clearly, the implications
of these findings are cause for concern and should serve as a warning to those thinking about using Ecstasy."
Parents' risky behavior rubs off on children Parents who smoke and drink and generally do not take care of their health
may influence their children to do the same, according to a new study that links parents' risky behavior to early sexual
activity in teens.
"Adolescents whose parents engage in risky behavior, especially smoking, are especially likely to be sexually active.
They are also more likely to smoke, drink, associate with substance-using peers and participate in delinquent activity,"
say study co-authors Esther I. Wilder of Lehman College and Toni Terling Watt, Ph.D., of Southwest Texas State University.
Adolescents of parents who smoked were around 50 percent more likely to have had sex. They were also more likely to
have had sex by age 15, Wilder and Watt report in the September issue of the Milbank Quarterly.
Teens with parents who drink heavily tend to drink as well, and teen alcohol use is closely linked to the early onset
of sexual activity, they explain. For boys, but not girls, parents' failure to wear seatbelts is associated with a modest
increased likelihood of adolescent sex.
"Because parents serve as important role models for their children, it stands to reason that parents who exhibit unsafe
behaviors are especially likely to have children with similar tendencies," the researchers say.
In contrast, high levels of supervision by parents resulted in a reduced likelihood of sexual activity in some children.
Boys whose fathers are present at key times of the day--when the leave and return from school and bed time--are less
likely to be sexually active, as are girls whose mothers are present at those times. However, mothers' presence has
no impact on boys' likelihood of being sexually active and fathers' presence has no impact on girls.
The researchers used data collected for the National Longitudinal Study of Adolescent Health, which includes information
on sexual behavior for approximately 19,000 adolescents in grades 7 through 12. The data set also provides information
on risky health behaviors, such as smoking, drinking heavily and not using a seatbelt, for one parent in each teen's
household.
Among the respondents, 37 percent of girls and 39 percent of boys reported having had sex. Nearly two-thirds of these
adolescents used a contraceptive, most often a condom, at first intercourse.
According to Wilder and Watt, however, unsafe parental behavior had little or no effect on whether the sexually active
teen uses contraceptives during his or her sexual encounter.
The researchers found little to explain why some teenagers use contraceptives and others do not, although the study
did show that one of the strongest predictors was the year in which the adolescent first had sex. Teenagers who first
had sex in 1991 or later were more likely to use contraceptives, likely reflecting the greater awareness of sexually
transmitted diseases inspired, in part, by the AIDS activism movement.
Teenagers whose parents engage in risky health behaviors are also more likely to engage in other risky behaviors,
such as smoking, drinking, associating with peers who use drugs and other delinquent behavior such as stealing and damaging
property, the study shows.
"Given the importance of parental risk in explaining both early sexual activity and a host of problem behaviors linked
to contraceptive nonuse," the researchers say, "public health campaigns that urge parents to act responsibly by engaging
in health-conscious behaviors are likely to help reduce precocious and unsafe sexual activity among teens."
NATIONAL STUDY YIELDS NEW DATA ON MISSING, RUNAWAY CHILDREN In the wake of a summer when tragic stories of abducted
and murdered children seemed to be making headlines daily, the results of a newly released national survey of missing
children present important new information on how many children actually become missing--and why.
The findings of the Second National Incidence Studies of Missing, Abducted, Runaway and Thrownaway Children (NISMART-2)
are being distributed in a series of Office of Juvenile Justice and Delinquency Prevention (OJJDP) bulletins and reports.
The first four bulletins were released at the White House Conference on Missing, Exploited, and Runaway Children on
Wednesday, Oct. 2, in Washington, DC, and are available to the public online at http://www.ojjdp.ncjrs.org.
NISMART-2 is based on a survey of over 16,000 households conducted by the Institute for Survey Research (ISR) at Temple
University plus studies of law enforcement agencies and juvenile facilities conducted by Westat, Inc. According to the
NISMART-2 findings, there were an estimated 1,315,600 children who were missing from their caretakers in 1999, and an
estimated 797,500 of these children, or 61 percent, were reported to authorities as missing.
"Media reports of a missing child conjure up frightening and tragic images, but the problem of missing children is
far more complex than the headlines suggest," says Heather Hammer, senior study director at Temple's ISR and principal
investigator for NISMART-2.
To provide an accurate estimate of the incidence of missing children in the U.S., and an assessment of the circumstances
under which children go missing, investigators identified five categories of missing child episodes:
--Nonfamily abductions (including the headline-making, stereotypical kidnappings) --Family abductions (including,
typically, those arising from custody disputes) --Runaway/thrownaway episodes --Involuntarily missing, lost or injured
events --Missing benign explanation situations (often the result of miscommunication)
Nonfamily Abductions
"It's important to understand that while notorious kidnappings such as Samantha Runnion, Elizabeth Smart and Danielle
Van Dam make headlines, they actually represent a fraction of all missing children abducted by a nonfamily perpetrator,"
Hammer said. And there is no indication that they are increasing in frequency, although we have no information about
abductions during the course of 2002, she added.
There were an estimated 58,200 children who were victims of nonfamily abduction in the study year. Of the 115 children
who were victims of a stereotypical kidnapping by a stranger involving elements of heinous crime--a child being abducted
overnight, taken long distances, held for ransom, or killed, 40 percent were killed, and another four percent were not
recovered.
Other incidents classified as nonfamily abductions include any child moved or detained by a nonfamily perpetrator
for a substantial period of time by physical force or threat, or a child who is abducted and sexually assaulted by a
nonfamily perpetrator and released. Among the examples of nonfamily abductions yielded by the National Household Survey
of Primary Caretakers conducted by the ISR were a babysitter who refused to let three children go home until she was paid;
a 15-year-old girl pushed into a boys' bathroom at school and sexually assaulted by several older boys; a four-year-old
taken on a 20-mile joy ride by a school bus driver.
While parents of younger children are particularly anxious about the danger of kidnapping, NISMART-2 revealed that
teenagers were the most frequent victims of both nonfamily abductions and stereotypical kidnappings. Eighty-one percent
of all nonfamily abducted children were age 12 or older. Girls were the predominant victims, reflecting the frequency
of sexual assault as a motive for many nonfamily abductions, the researchers noted. Nearly half of all nonfamily abduction
victims and stereotypical kidnapping victims were sexually assaulted.
An estimated 203,900 children were victims of a family abduction (the taking or keeping of a child in violation of
a custody agreement involving some element of concealment, flight, or intent to alter custodial rights permanently),
and in more than three-quarters of these cases, the perpetrator was a parent: 53 percent were abducted by their biological
father, 25 percent by their biological mother.
"These children actually reflect a much larger problem," Hammer pointed out. "A child can be unlawfully removed from
custody by a family member and yet the child's whereabouts are fully known. A child abducted by a noncustodial parent
and taken to that parent's home out of state has been abducted but is not necessarily missing." Family abducted children
accounted for only 9 percent of all missing children and 7 percent of those reported missing in the study year.
In family abductions, younger children appear to be more vulnerable. Teenagers, who have relatively more independence
and control over where they go and stay, accounted for a relatively small proportion of family abduction victims.
Runaways/Thrownaways
In 1999, there were an estimated 1,682,900 runaway/thrownaway youth, 37 percent of whom were missing. Runaway/thrownaway
youth include children who leave home without permission and stay away overnight; children who are away from home and
choose not to return and stay away either one or two nights, depending on their age, and children who are asked or told
to leave home by a parent or other adult, or prevented from returning home when adequate alternative care has not been
arranged. Runaways/thrownaways accounted for 48 percent of all missing children and 45 percent of those reported missing
in the study year.
"These numbers, too, represent a complex set of problems. Children who leave home do so for a variety of reasons.
More than one-quarter of these were children either using hard drugs or substance dependent. One in five had been physically
or sexually abused at home or afraid of abuse upon return," Hammer stated.
Although the stereotype of the runaway is a youth roaming and sleeping on the streets of a big city, prey to drugs
and violence, some youth leave home for the homes of friends and relatives, where they may be well cared for. "These
are two ends of a continuum of runaway/thrownaway episodes which can vary a great deal in their seriousness and level
of danger," the researchers noted.
Missing Involuntarily, Lost, or Injured This category describes missing children who are trying to get home or
make contact with the parent/caretaker and are unable to do so because they are lost, stranded or injured; or children
who are missing because they are too young to know how to return home or make contact. Of the estimated 1,315,600 missing
children in 1999 (including both those reported missing to authorities and those not reported), 198,300, or 15 percent,
were categorized as involuntarily missing, lost, or injured.
Investigators will issue a detailed bulletin analyzing the demographics of this group and the characteristics of these
episodes later this year.
Missing Benign Explanation This category is comprised of children who cannot be classified in any of the prior
categories, but become "missing" because of a benign reason such as miscommunication with their parents. In 1999, they comprised
43 percent of all children who were reported as missing to authorities.
Investigators will issue a detailed bulletin analyzing the demographics of this group and the characteristics of these
episodes later this year.
"It is vital that parents, and policymakers, understand the complexities of the problem of missing children," says
Hammer. "Not all missing children are endangered, and most are not abducted. The challenge is figuring out how to differentiate
the innocuous episodes from the serious ones. Also, many children become missing because of family conflicts or maltreatment,
problems that need to be addressed in addition to locating and returning the child home. We believe this study yields
important new data that take an important first step in shaping strategies for keeping children safe."
A guide for parents titled "Personal Safety for Children" developed by the White House and including selected findings
of NISMART-2 is available to the public online in both English and Spanish at www.missingkids.com under the Education and Resources link. The guide will also be distributed to every school child in America. The pamphlet
is designed to serve as a resource to help parents understand and talk to their children about the risks and provide safety
tips for protecting against abduction.
The full text of the initial NISMART-2 bulletins (Qs & As, Overview of Missing Children, Children Abducted by
Family Members, Nonfamily Abducted Children, Runaway/Thrownaway Children) is available at the Office of Juvenile Justice
and Delinquency Prevention website: http://ojjdp.ncjrs.org/pubs/new.html
Therapies: For Addiction, a Change of Venue October 15, 2002 By JOHN O'NEIL - - NY Times A new drug and changes
in federal regulations should help move treatment of heroin addiction out of methadone centers and into doctors' offices,
the author of an article being published today in The Annals of Internal Medicine says.
Fewer than a quarter of the nation's estimated 800,000 heroin addicts are believed to receive treatment, according
to the article by Dr. David A. Fiellin of the Yale School of Medicine. Many treatment centers have long waiting lists,
and many addicts, especially those still with jobs and families, wish to avoid the stigma associated with drug treatment
centers, Dr. Fiellin said in an interview.
Five years ago, a federal panel concluded that treatment with an opioid agonist - a drug like methadone that undercuts
the euphoric effort without bringing on withdrawal symptoms - could be effective when combined with counseling. Since
then, efforts have been made to make such care more accessible, Dr. Fiellin said.
He said the biggest step was the approval last week by the Food and Drug Administration of a new partial agonist,
buprenorphine, which studies have shown to be almost as effective in preventing relapse as methadone.
Buprenorphine has some clear advantages, Dr. Fiellin said. It is less mood-altering, and when combined with an opioid
blocker it is harder to abuse. That has let it qualify for a less restrictive category of controlled substances, he
said, opening it to office use by trained physicians. "Our expectation is that it will increase access to treatment
for a large population of patients," he added.
Other changes in federal regulations are beginning to make it possible for physicians working in partnership with
drug programs to treat stable methadone patients in regular medical offices.
Dr. Fiellin said studies had shown that office treatment was as effective as methadone clinics for stable patients
and was more satisfying. They "felt that they were finally being recognized for their stability, by being able to receive
their treatment in a more medical setting," he said.
Contact: Ming Tai or Tim Parsons mtai@jhsph.edu 410-955-6878 Johns Hopkins University Bloomberg School of Public Health Marijuana use linked to hallucinogen use Young
marijuana smokers more likely to have the opportunity to use hallucinogens A study from the Johns Hopkins Bloomberg School
of Public Health provides the first epidemiological evidence that young marijuana smokers are substantially more likely
than non-smokers to be presented with the opportunity to try hallucinogens. Once the opportunity for hallucinogen use
occurs, marijuana smokers are more likely than non-smokers to actually try it. The study appears in the April issue
of Drug and Alcohol Dependence.
"Research in the past has focused on the causal relationships of drugs, but our study is the first to support the
idea of two separate mechanisms linking marijuana and hallucinogen use -- that of increased opportunity and increased
use once given the opportunity," says lead author Holly Wilcox, a doctoral candidate in the department of mental hygiene
at the Johns Hopkins Bloomberg School of Public Health. "Insight into this area teaches us about mechanisms that might
help guide new progress for prevention of drug problems."
For the investigation, the researchers used self-report data from more than 40,000 young participants in the 1991
to 1994 National Household Surveys on Drug Abuse (NHSDA). From this data, they were able to extract information about
the age at which young people first had the opportunity to use different drugs and the age at which they first tried
them. They focused on the availability and use of two drugs: marijuana (cannabis, reefer, blunts, hash oil, or any other form
of marijuana use) and hallucinogens (LSD, mescaline, mixed stimulant-hallucinogens, and PCP).
The results showed that by age 21, almost one-half of the teenagers who had smoked marijuana had a chance to try a
hallucinogen, compared to only one in 16 of the teenagers who had never smoked marijuana. Within a time period of one
year after the first chance to use a hallucinogen, two-thirds of marijuana smokers actually tried it, compared to only
one in six of the teenagers who had never smoked marijuana.
"This large difference between marijuana smokers and non-smokers may be attributed to the social influences in a marijuana
smoker's life. Young people who are using marijuana sometimes develop contacts with illegal drug dealers who may try
to push other drugs like Ecstasy or LSD," explains James C. Anthony, PhD, a professor of mental hygiene, psychiatry,
and epidemiology at the Johns Hopkins Bloomberg School of Public Health and School of Medicine. "Also, marijuana smokers
often are members of social circles where drug use and experimentation is more common, and friends are likely to share
drugs. In addition to trying to persuade young people to not use drugs, it may be worthwhile for us to persuade users
to not share their drugs with friends."
The authors say further research is needed to account for variations in exposure opportunities experienced by marijuana
smokers and to understand why some marijuana smokers choose not to use hallucinogens once given the opportunity. "Such
research should lead toward new ideas for prevention of hallucinogen use," concludes Ms. Wilcox.
Springtime brings out feelings of despair, hopelessness for many Peak season for suicide More people kill themselves
at this time of year than any other, though experts aren't sure why By Thrity Umrigar Beacon Journal staff writer The
Beacon Journal Akron OH
On April 25, 1995, Beth Wood took about 40 painkillers with alcohol and went to bed. To her dismay, she was discovered
by her then-boyfriend early the next morning and rushed to the hospital. She lived.
Each year, about 30,000 Americans are not so lucky.
And with the arrival of spring, mental health experts have been bracing themselves for a spike in the number of suicides.
For most people, spring is a season of hope, a time of renewal and rebirth.
But for some, it is a season of despair. More Americans kill themselves in the spring than at any other time of the
year. Suicide rates normally spike in April and again in summer. Contrary to popular belief, suicide rates drop during
the winter holiday season.
An average of 80 Americans kill themselves each day. That's one person every 18 minutes.
In 1999, the most recent year for which national statistics are available, 29,199 Americans committed suicide. That
same year, there were 16,899 homicides in the United States.
Another 730,000 people tried to kill themselves in 1999 but were not successful. An estimated 5 million living Americans,
like Wood, have attempted suicide at some point in their lives.
For all the public awareness campaigns -- for instance, May is designated as Suicide Prevention Month -- many myths
still surround the issue. The American Association of Suicidology tries to combat them by presenting such facts as these: *
The majority of suicides -- 72 percent -- are committed by white men.
* White men over age 85 have the highest suicide rate -- 59 per 100,000.
* Suicide is the third-leading cause of death among young people ages 15 to 24, following accidents and homicide.
The rate in this age group is 10.3 per 100,000.
* Men commit suicide four times more than women, but women attempt suicide three times more than men.
* The strongest risk factors for attempted suicide in adults are depression, alcohol abuse, cocaine use, and separation
or divorce.
* The strongest risk factors for attempted suicide in young people are depression, alcohol or drug use, and aggressive
or disruptive behaviors.
Season of death
Experts are not sure why spring becomes a season of death for so many people, but they have some guesses.
``In the spring, they expect they'll feel better,'' said Barb Medlock, who runs the support hot line at Portage Path
Behavioral Health in Akron. ``And they don't. It's a disappointment on top of other life stresses. It increases their
hopelessness.''
Wood, a 38-year-old Akron resident, recalls how depressed she was before her suicide attempt.
``There was nothing to do, nowhere to go,'' Wood said. ``I was horribly depressed, but I was the most functional depressed
person you'll ever meet. I would go to work, do what I had to do.''
She had been contemplating suicide for at least six months before her attempt that April.
``The birds are singing, flowers blooming, life is regenerating,'' she said. ``You feel, `How come my life isn't coming
along, how come I'm not growing?' ''
At the time of her attempt, Wood was living with her boyfriend. She had quit her job, her finances were a mess and
she had been estranged from her family for a year. She was convinced that ``nobody would miss me because I turned into
such a worthless person.''
Medlock said many suicides are a cry for help, but that cry may be as vague as a statement like, ``I just don't know
if I can deal with this anymore.''
``The important message is that 90 percent of people have some emotional problem that's treatable,'' she said. ``People
live their lives and run into emotional problems they can't solve. Their coping skills are not good. Hopelessness builds
and they think this is a way of getting away from pain.''
Wood has been on both sides of the suicide continuum. She cringes at the memory of waking up in the hospital and seeing
her family standing around her bed. She had believed that killing herself would make it easier for them to go on with
their lives. One look at their stricken faces told her otherwise.
Her family stood by her. So did her friends, including one who killed himself last year.
``Prior to my friend's death, I would've said everybody has the choice to take his own life,'' Wood said. ``I have
a different take on this now. I think suicide is stupid and selfish.''
Distorted thinking
Yet she remembers how distorted her thinking was at the time.
``You don't feel it's selfish when you're in that place,'' she said. ``You're thinking you're going to make things
better (for the people around you).''
Ellen Botnick of Copley is proof that isn't true. Her daughter, Lisa, a 15-year-old sophomore at Revere High School,
killed herself in October 2000.
``I still think about her with every breath I take,'' Botnick said. ``I think about the magic she had in everything
she touched. I feel very much alone and something's missing.''
In her daughter's memory, Botnick is planning on participating in the Out of the Darkness walk that will commence
in Fairfax, Va., on Aug. 17. Participants will walk 26 miles and arrive in Washington, D.C., the next day.
She is making the walk ``to raise awareness. The whole issue (of suicide) is cloaked in silence. This silence has
to be broken. People can be helped.''
On the first anniversary of her suicide attempt, Wood's mother bought her a ring.
``I look at it as my second birthday,'' Wood said. ``It was the day I was able to start again.''
Which is not to say the climb back has been easy. After leaving the hospital, Wood went into a residential treatment
program for two weeks and then moved in with her mother for a time. She received therapy for months.
``The suicide attempt was the best thing that ever happened to me,'' she said. ``It gave me a chance to ask for help.'' Thrity
Umrigar can be reached at 330-996-3174 or at tumrigar@thebeaconjournal.com
More College-Age Students Victims of Sex Crimes Related to Excessive Drinking-(U. South Florida) U-WIRE - April
19, 2002 (U-WIRE) TAMPA, Fla. -- A new report released earlier this month said approximately 1,400 deaths and 700,000 sexual assaults,
all alcohol related, occur each year -- a trend that is only getting worse. Drinking among American college students has resulted
in many other consequences, too, according to the report released by the National Institute on Alcohol Abuse and Alcoholism.
The NIAAA developed a task force in 1998 to examine these dangerous effects and consequences that are caused by alcohol.
Mark Goldman, a University of South Florida psychology professor and co-chair for the task force, worked with 15 college
presidents and 17 other researchers who have worked in the field of psychology and alcoholism to help change the culture
of drinking on campus.
"We spent three years reviewing literature, reports on alcohol use in college and we also looked at the efforts that
were trying to be made in drinking in college," Goldman said.
The drinking consequences are not limited to students who drink. More than 600,000 students between the ages of 18
to 24 are assaulted by another student who was drinking. Also, 400,000 students had unprotected sex, and more than 100,000
were too intoxicated to know whether they consented to have intercourse.
"The consequences of excessive drinking are far too common on many college campuses nationwide, and efforts to reduce
high-risk drinking and its related problems have largely failed," Goldman said.
Goldman worked alongside Rev. Edward Malloy, president for the University of Notre Dame. Both Goldman and Malloy were
a part of the National Advisory Council on Alcohol Abuse and Alcoholism and were then appointed to the task force. The
task force created two panels, the Panel on Contexts and Consequences and the Panel on Prevention and Treatment.
Goldman said one of the main reasons for the interest in the task force was because of recent reports pertaining to
problems concerning college drinking.
"In recent years there has been a few public and media announcements with drinking," Goldman said. "One, for example,
was a student who died at (Massachusetts Institute of Technology) MIT due to alcohol influence."
According to a related article in the Washington Post, the new national estimates of alcohol-related deaths and injuries
show that the consequences of heavy drinking by some students are far greater than previously understood.
The Harvard School of Public Health College Alcohol Study (CAS) conducts an ongoing survey of over 15,000 students
at 140 four-year colleges in 40 states each year. The CAS examines high-risk behaviors, such as heavy drinking and smoking
among college students.
The 2001 rates of binge drinking at 119 CAS colleges were remarkably similar to those found at the same institutions
in 1993, 1997 and 1999. Nationally two out of five undergraduate college students were binge drinkers -- a statistic
that hasn't changed since 1993.
Approximately 31 percent of college students responding to a national survey in 1999 accepted criteria for a diagnosis
of alcohol abuse, according to a new study by the Harvard researchers cited in the report by the NIAAA's task force.
Emanuel Donchin, chair for the Department of Psychology at USF, said Goldman has been investigating the issues of
alcoholism for a long time and deserved the position of co-chair for the task force.
"He is one of the top scholars in this city and in the country on the subject," Donchin said. "It was only natural
to have picked him because he has a large body of research to his credit."
Goldman has worked on several research projects that were provided federal funding. He is also board certified in
clinical psychology and a member of the American Psychological Association's physiological division and the neuropsychology
division. Goldman has also served as an editor on many journal boards that deal with alcoholism and psychology.
Donchin said with all his credentials, he is a distinguished professor at the University of South Florida.
"He teaches graduate and undergraduate students," Donchin said. "He has a very large and well-respected program with
research in alcoholism."
Goldman said the task force came out with a report on April 9 and mailed a copy of the report to every college in
the United States for review. The report included strategies for dealing with the problem within the college community,
as well.
"What everyone has to do is get on the same page," Goldman said.
Goldman said with USF being so close to Ybor City there should be some way that the university and the business owners
can work together.
Terry Gordon, lieutenant for the University Police, said that USF's alcohol-related arrests have been few this semester.
From Jan. 1 to April 7, there were six arrests for underage possession of alcohol, 12 arrests for driving under the
influence, and there were no arrests for zero tolerance. Zero tolerance is an administrative charge that goes against
a student's driver's license.
"If a student is driving in the car and is up to the age of 21 and is not so intoxicated but found with alcohol in
their system, it is zero tolerance," Gordon said.
Gordon said zero tolerance is not as bad as a DUI charge, but the student has to go through an administrative hearing
and gets points on his or her license if under the age of 21.
"We are trying to keep kids from drinking underage," Gordon said.
UP hands out pamphlets to students and their parents at orientation, Gordon said. The pamphlet, Century Council, is
made up of a bunch of beverage distributors that target parents.
"They give them advice on what they need to ask and tell their child before entering their first year in college,"
Gordon said. The NIAAA task force report also makes recommendations on a variety of strategies to prevent student alcohol
abuse. They also urge that more research should be conducted.
The task force developed what it calls a "Three-in-One framework" that encourages the universities to consider the
broad effects of college drinking. The framework is a four-tier plan that rates prevention efforts from effective to
ineffective.
Goldman said the force wants to make sure that it not just provides information to colleges but also implements concrete
programs to help the universities.
"We want to kick off a process that would put something in place to have colleges have researchers examine the new
programs and measure that the program works," Goldman said.
"We want a more constructive process."
Breaking Bonds of Addiction: Compulsion Traced to Part of the Brain USA TODAY - April 18, 2002 Joe Duavit says
he turned to crystal meth, or speed, in college to help study for exams.
But the powerful upper also gave him a high, and an addiction that consumed him. He began to steal from his family
to support his habit, going on binges that would last for days.
''I ended up in a straitjacket in a psychiatric ward,'' says Duavit, who in 1992 finally conquered his addiction.
He now works for Habilitat, a drug treatment center in Kaneoho, Hawaii.
The urge to take the drug again was the most difficult part of the recovery process, Duavit says. New research may
help explain why drug abusers struggle so much with the compulsion to take such a risky drug again and again.
A scientific study now suggests that compulsion can be traced back to damage to a part of the brain involved in making
good decisions. Yet people such as Duavit do recover -- often with the help of therapy. Studies also now suggest that
the brain may heal itself after a person stops abusing a drug, a finding that indicates that recovery may get easier as
time goes on.
Biology of addiction
Such research offers insight into the biology of addiction to meth, cocaine and other illegal drugs. Such knowledge
may one day help researchers find new treatments to help combat addictions.
Scientists now know these drugs work by telling brain cells to crank out a natural chemical called dopamine. It is
dopamine that tells the brain to register a sensation of intense pleasure. But in the process, the drug injures those
brain cells and others. Over time, that damage makes it harder for abusers to get pleasure from anything but the drug.
Methamphetamine, which goes by a number of street names, such as ice, crank, crystal meth or chalk, offers a cheap,
powerful high. Once confined to the West Coast, the drug has become popular across the country.
That spread worries scientists such as Nora Volkow of the U.S. Department of Energy's Brookhaven National Laboratory
in Upton, N.Y. She says methamphetamine is one of the most damaging drugs she has studied.
Drugs such as cocaine and meth work by getting brain cells to crank out massive amounts of the neurotransmitter dopamine.
After dopamine is released, it fits into a specialized protein receptor on other brain cells. The end result is a rush
of pleasure.
But when it comes to drug abuse, the pleasure comes at a price. Researchers know that cocaine and heroin reduce the
number of dopamine receptors on brain cells. Fewer receptors mean that the addict may need a huge wave of dopamine to
get much of a feeling of pleasure at all.
Volkow's team wondered whether meth could do the same thing. To find out, the team gave 15 meth abusers injections
of a radioactive substance that fits with the dopamine receptor. With an imaging method called pos- itron emission tomography,
or PET, they took snapshots of the brain.
In the December American Journal of Psychiatry , the Brookhaven team reports that meth addicts had 15% fewer dopamine
receptors than people who had never abused the drug.
With fewer dopamine receptors in the brain, the methamphetamine addict may not get the usual message of pleasure from
everyday activities, says Glen Hanson, acting director of the National Institute on Drug Abuse.
This theory suggests that addicts must come back to the drug again and again, because nothing else gives them much
satisfaction.
Meth affects more than just the dopamine receptor. The drug also injures brain cells that manufacture dopamine. In
the short term, meth makes cells release dopamine, but over time, the damaged cells produce less and less dopamine.
That means a meth addict may turn to the drug, seeking to ramp up his dopamine production, says Wilkie Wilson, an addiction
expert at the Duke University Medical Center in Durham, N.C.
''People take these chemicals to get a pure dopamine release,'' he says. But the drugs damage the brain in the process,
a problem that helps sustain the addiction, he says.
When methamphetamine injures the brain cells that make dopamine, it also sets the addict up for another risk, one
related to another function that dopamine plays in the human brain. Scientists know dopamine helps people move about and
remember new information. A loss of dopamine means addicts may have trouble with learning things or with motor skills,
Wilson says.
Yet the scientific studies also carry a message of hope for those, such as Duavit, who stop using meth.
Volkow's team studied meth addicts who had stayed off the drug for up to nine months. They compared brain scans of
those recovering addicts with scans of people who had never used the drug. In the December issue of the Journal of Neuroscience
, Volkow's team reports that some brain cells had recovered from the damage the drug had done.
A healing process
But when the team gave the addicts a series of memory and motor-skill tests, they did not find a significant improvement
in their abilities. That may simply mean that the brain needs more time to heal.
Duavit didn't notice any memory problems after he quit meth. But he did have to learn how to take pleasure in things
that many people take for granted. He says he had to learn how to get satisfaction from working hard toward a goal, such
as getting a college degree.
And, over time, Duavit did experience a healing, in his case one that freed him from a seven-year addiction to meth.
Now as a drug treatment counselor, he looks for another kind of high, one that he gets from helping others break free
of drug addiction.
Teen Substance Abuse Could Increase Psychological Woes HealthScout - November 12, 2002 TUESDAY, Nov. 12 (HealthScoutNews)
-- Teens and young adults who abuse alcohol and drugs could be increasing their odds of psychological troubles down
the road, new research says.
While other studies have confirmed an association between early drug abuse and later psychological disorders, there
has been a chicken-and-egg controversy about the link: Is drug and alcohol abuse primarily due to pre-existing psychological
disorders, or are the disorders a result of drug and alcohol abuse?
In a new, longitudinal study, researchers at the Mount Sinai School of Medicine in New York followed more than 700
people, aged 14 to 27, for 14 years and found that alcohol and drug use is in itself significantly associated with psychological
disorders in the late 20s.
"The fact that we are able to predict this is new, startling and alarming. It used to be thought that the link only
went the other way," says Dr. David W. Brook, a Mount Sinai psychiatrist and one of the authors of the study.
The results of the study appear in the November issue of The Archives of General Psychiatry.
In the study, Brook and his colleagues, including his wife and collaborator Dr. Judith Brook, did interviewed 736
people, chosen randomly from upstate New York communities, aged 14, 16, 22 and 27. The researchers used a standard diagnostic
questionnaire to measure psychiatric disorders and also assessed the participants' alcohol, drug and tobacco use.
All interviews were conducted in the participants' homes by trained interviewers, and those participants who moved
away were interviewed by phone or mailed questionnaires. Half the respondents were female and there were no gender differences
in the result. The study is one of several conducted using data from authors' long-term "The Children in Community Study,"
which is funded by the National Institute on Drug Abuse.
Age-appropriate psychological questions using the University of Michigan Composite International Diagnostic Interview
included whether a person had diminished interest in daily activities, felt excessive fatigue on a daily basis, had
unexplained weight fluctuation, was in a depressed mood or thought about dying often.
The questions are aimed at diagnosing major depressive disorders, but do not address other major psychiatric illnesses,
such as bipolar disorder or schizophrenia.
Participants were also asked to report on their tobacco, alcohol, marijuana and other illegal drug use. Measures used
for assessment for each category were rating systems grading use from none to the maximum of the following: Cigarettes,
one-and-a-half packs daily; alcohol, three or more drinks a day; marijuana and other illegal drugs, daily use.
The results, Brook says, showed that the cumulative frequency of drug use, including alcohol, marijuana and other
illegal drugs, during adolescence and early adulthood were associated with episodes of major depressive disorders, alcohol
dependence and substance use disorders in the late 20s. In that age group, 8.3 percent of participants qualified for a
diagnosis of depressive disorder, 5.2 percent qualified as having alcohol dependence and 6.1 percent showed substance
use disorders.
Increased tobacco use was associated with an increased risk for alcohol dependence and substance use disorders but
not with depressive disorders among those in their late 20s.
"This should be a signal to policy makers as well as concerned parents to look around and see what's happening," Brook
says.
Michael Nuccitelli, executive director of SLSHealth, an adolescent and early adult drug and alcohol rehabilitation
center in Brewster, N.Y., agrees.
"Oftentimes, parents minimize their childrens' alcohol and drug use. They perceive that it's social usage and don't
set parameters for their children," says Nuccitelli.
"But with this study, because it's longitudinal, we can take this to our patient population and their parents and
we can say this usage is a predictor of future psychopathology," he adds.
Cannabis increases risk of depression and schizophrenia
Cannabis use and mental health in young people: cohort study BMJ Volume 325, pp 1195-8
Frequent cannabis use increases the risk of developing depression and schizophrenia in later life, according to three
studies in this week's BMJ.
In the first study of 1,600 students from 44 secondary schools in Australia, frequent cannabis use predicted later
depression and anxiety, particularly in teenage girls.
Some 60% of participants had used cannabis by the age of 20 and 7% were daily users. After adjusting for use of other
substances, daily use in young women was associated with a more than fivefold increase in the odds of later depression
and anxiety. Weekly or more frequent use as a teenager predicted a twofold increase in later risk.
Given recent increasing levels of cannabis use, measures to reduce frequent and heavy recreational use seem warranted,
suggest the authors.
The second study clarifies earlier findings that cannabis is associated with later schizophrenia and that this is
not explained by use of other psychoactive drugs or personality traits. The results show that use of cannabis increases
the risk of schizophrenia by 30%.
The weight of evidence is that occasional use of cannabis has few harmful effects overall, say the authors. Nevertheless,
these results indicate a potentially serious risk to the mental health of people who use cannabis particularly in the
presence of other risk factors for schizophrenia. Such risks need to be considered in the current move to liberalise
and possibly legalise the use of cannabis in the United Kingdom and other countries, they conclude.
In the third study, researchers found that using cannabis in adolescence increases the likelihood of experiencing
symptoms of schizophrenia in adulthood, with the youngest cannabis users (by age 15) at greatest risk. These findings
suggest that cannabis use among psychologically vulnerable adolescents should be strongly discouraged, while policy
and law makers should concentrate on delaying onset of cannabis use, say the authors.
The shown dose-response relation for both schizophrenia and depression highlights the importance of reducing the use
of cannabis in people who use it, write two psychiatry experts in an accompanying editorial.
Body-Conscious Boys Adopt Athletes' Taste for Steroids November 22, 2002 By TIMOTHY EGAN - - NY Times CLEARFIELD,
Utah - They want to be buff. They want to be ripped. They want to glisten with six-pack abs and granite pecs like the
hulks on Wrestlemania.
But more than ever, American boys are trying to find designer bodies not just in a gym but also in a syringe of illegal
steroids, or a bottle of the legal equivalent from a mall nutrition store, law enforcement officials, doctors and teenagers
say.
Steroid use has long been widespread among athletes looking for a quick way to add strength or speed. Athletes "on
the juice," as the term goes, can be found in nearly any high school or college or among the ranks of top professional athletes.
But now boys as young as 10, and high school students who do not play team sports, are also bulking up with steroids or
legal derivatives like androstenedione - known as steroid precursors - simply because they want to look good. The growing
use of such substances, which doctors say can lead to side effects that basically shut down normal adolescent development
in male bodies, has also created problems for law enforcement.
The narcotics police who usually spend their days raiding methamphetamine laboratories in this prosperous county along
the Wasatch Mountain front got some idea of the market demand earlier this year when they broke up a high school steroid
ring. Three students were caught after returning from Mexico in a van with steroids and other drugs bought at a veterinary
supply store in Tijuana, the police said.
The plan was to sell the steroids - the possession or dealing of which is a felony - to fellow high school students
throughout Davis County, the police said.
"These are injectable steroids, very powerful, and these kids weren't just going to sell them to the football players,"
said Dave Edwards, an officer with the Davis Metro Narcotics Strike Force. "They had a lot of customers, kids who will
do anything to get that buff look."
New York has its suburban gyms where some bodybuilders drink protein shakes laced with steroids or androstenedione,
known as andro, and California has its beach body shops where people take a similar path to what has been called reverse
anorexia.
But it is in the high schools of middle America, and the gyms that cater to students off campus, where use of body-enhancing
drugs has taken off - particularly among nonathletes. And for all the recent concern about an epidemic of youth obesity,
the mania over instant bulk shows another side of the struggle for self-image.
"Everybody wants to be big now," said Zeb Nava, a senior at Clearfield High School who has added nearly 50 pounds
of muscle mass over the last two years by weight lifting, he said, adding that he had avoided all supplements. "The majority
now are guys that don't do it for sports. They do it for girls. For the look."
Nearly half a million teenagers in the United States use steroids each year, according to the latest national survey done
for federal drug agencies. While the use of other illegal drugs has fallen or leveled off, the number of high school
seniors who had used steroids within a month increased nearly 50 percent last year, the survey found.
Among high school sophomores, steroid use more than doubled nationwide from 1992 to 2000, according to the annual survey
used by the National Institute of Drug Abuse.
Another survey, done last year for Blue Cross Blue Shield, found that use of steroids and similar drugs increased
by 25 percent from 1999 to 2000 among boys ages 12 to 17. This study, a national survey of 1,787 students, also found
that 20 percent of the teenagers who admitted taking body-enhancing drugs did it because they wanted to look bigger,
not because of sports.
Preston Alberts, a senior at Clearfield High who has been working with weights in the school gym for three years, said
he had seen a different kind of lifter of late in the weight room: the vanity bodybuilder.
"We notice a lot of kids now, they just want this certain type of body - with the abs and the ripped chest - and they want
to get it quick," Mr. Alberts said.
Sales of legal, largely unregulated steroid precursors like andro have soared among the young, according to recent Congressional
testimony by doctors and officials in the supplement industry, prompting a move in Congress to have them treated as
illegal drugs when they are not prescribed. These precursors, which metabolize into steroids once ingested, are perhaps
the main reason why sports nutrition supplements are the largest-growing segment of the $18 billion dietary supplement
industry.
Andro use increased after Mark McGwire, the former St. Louis Cardinals slugger, said he used it. Mr. McGwire cautioned
that people under 18 should not follow his example.
Steroid precursors can bought over the counter at health stores or supermarkets. While the labels say people under 18
should not take them, they are aggressively marketed over the Internet with promises like, "You'll get huge!"
Representative John E. Sweeney, Republican of New York, said he found out about the bodybuilding drugs through his teenage
son.
"My 16-year-old son, who goes to a Catholic military school, told me some of his fellow students were using andro
and he wanted to know what I thought," Mr. Sweeney said. "I was stunned. He said some of the kids were taking andro
and getting really big."
Recently, Mr. Sweeney co-sponsored a bill, along with Representative Tom Osborne, Republican of Nebraska, to make over-the-counter
sales of steroid precursors illegal. Mr. Osborne, who was coach of the University of Nebraska football team for 25 years,
said the precursors "have the same effects and dangers as steroids."
Similarly, a number of pediatricians said in Congressional testimony last summer that they did not distinguish between illegal
steroids and legal precursors.
While some of the products guarantee a rack of rippling muscles in five weeks or less, many of these compounds can actually
stifle bone growth, lead to testicular shrinkage, liver tumors and development of male breasts, doctors warn. Some of
these effects can be irreversible, like stopping bone growth in children who would otherwise continue to develop, according
to recent medical testimony in Congress. Steroids do this by falsely signaling to the body to stop producing its own
testosterone.
Here at Clearfield High School about 40 miles north of Salt Lake, the school has built a large weight room to accommodate
the demand by students who want to attain the look. Classes run all day, with upward of 150 students lifting weights
at a time.
The principal, Mike Timothy, said he could sometimes tell which students were using steroids or precursors not just because
their appearance had changed so drastically, but because they were also quick-tempered. It is called " 'roid rage."
"Suddenly, you've got some kids who are ready to fight at the drop of a hat," Mr. Timothy said.
Although none of the students charged with bringing steroids in from Mexico went to Clearfield, the police say they
had numerous customers among the students at the school, and two others in the county. The students were prosecuted
in juvenile court.
"At first, the parents and some of these school officials were in denial about what's going on," said Lt. Ted Ellison of
the narcotics strike force. "But since then, I've had several parents come forth saying they found syringes and pills
at home. Around here, it's such a `wow.' These are good kids, from good families, no criminal records, cream of the
crop."
Many in Congress are now calling for restrictions on steroid precursors and other sports supplement drugs. Senator
Orrin G. Hatch, the Utah Republican who pushed through the 1994 law, which opened the floodgates to largely deregulated
sales of dietary supplements, has asked the Food and Drug Administration to see if steroid precursors meet the definition
of a controlled substance.
"It's very possible these so-called steroid precursors such as androstenedione do not meet the legal definition of
a dietary supplement," Mr. Hatch said.
The supplement industry is against the effort to put a legal crimp in the precursor market. While acknowledging that
the drugs can be harmful to people under 18, industry officials say they can be used legitimately by adults, to help
recover from muscle injuries, for example, or to improve strength and endurance. The solution to teenage abuse is to
make sure clerks do not sell them to people under 18, they say.
"I'm not supposed to use this analogy, but cigarettes are out there as well, and we are finally getting good enforcement
of laws prohibiting sales of them to people under 18," said John Cardellina of the Council for Responsible Nutrition,
a supplement industry trade group.
But young bodybuilders say the pills and solutions that promise muscle makeovers are ubiquitous, legal or not.
"Guys know what the side effects are," said Mr. Alberts, the Clearfield senior. "But a lot of them just don't care. It's
like, this is how you get big quick. You get on the juice."
Suicidal behavior among alcoholics * Alcoholics have a much higher rate of death by suicide than do members of
the general population. * Those alcoholics with a history of suicide attempts appear to have a significantly more severe
course of alcohol dependence than other alcoholics. * The fathers, mothers and siblings of alcoholics who had attempted suicide
also showed a significantly higher prevalence of suicide attempts.
Contemplating suicide is very common, according to a 1997 article in the New England Journal of Medicine. In fact,
up to one third of the general population has thought about suicide at some point in their lives.
The strongest predictor of suicide is psychiatric illness; more than 90 percent of people who commit suicide have
diagnosable psychiatric illnesses at the time of death, usually depression, alcohol abuse, or both. The lifetime risk
for suicide completion among alcohol-dependent individuals has been reported to be almost 10 percent, which is five to
10 times greater than that found among the general population. A study in the April issue of Alcoholism: Clinical &
Experimental Research seeks to identify risk factors for suicide attempts among a large family-based sample of alcoholics
from the Collaborative Study on the Genetics of Alcoholism (COGA).
"We found that alcohol-dependent individuals with a history of suicide attempts had a significantly more severe course
of alcohol dependence," said Marc A. Schuckit, principal COGA investigator at the University of California San Diego
site, also of the Veterans Affairs Medical Center, and corresponding author for the study. "They also had a higher prevalence
of both independent and substance-induced psychiatric disorders, as well as other substance dependence." Schuckit speculated
that increased alcohol intake by this subgroup of alcoholics may have led to more severe problems, which may have then
resulted in brain dysfunction, neuropsychological changes and subsequent judgment impairment, an increased likelihood of
mood swings, and alcohol-related violent behavior. All of these factors could have contributed to life problems, as
well as suicide attempts.
For this COGA investigation, 3,190 alcoholic men and women were given semi-structured, detailed interviews. Information
about suicidal behavior, socioeconomic characteristics, psychiatric comorbidity, substance-use disorders and characteristics
of alcohol dependence were obtained from the alcohol-dependent probands (original subjects of the study), their relatives, and
controls (families without a history of alcohol dependence).
Of the total number of alcoholics, 522, or more than 16 percent, had a history of ever having attempted suicide, whereas
2,668, or close to 84 percent, did not. First-degree relatives (fathers, mothers and siblings) of individuals who had
attempted suicide also showed a significantly higher prevalence of suicide attempts than other alcoholics, but - according
to previous research - no enhanced rate of alcohol dependence, psychiatric comorbidity, or other substance-use disorder.
This suggests that suicidal behavior may be transmitted in families independent of alcohol dependence, psychiatric disorders,
or other substance-use disorders.
"Is there a suicide gene? Probably not," said Robert M. Anthenelli, associate professor of psychiatry in the College
of Medicine at the University of Cincinnati, and director of substance dependence programs at the Cincinnati Veterans
Affairs Medical Center, "but that's beyond the scope of this paper's findings. What this finding does is give some support
for the idea that 'suicidality' or suicide attempts seem to run in families. However, family studies rarely do a good
job of teasing out nature versus nurture, or genetics versus environment. What this study does nicely is show that a suicidal
'trait' seems to exist independent of substance-abuse disorders as well as other psychiatric disorders."
Anthenelli added that the size of the study makes the associations found between suicidality and alcohol dependence
more meaningful and believable than similar findings in previous, smaller studies. "Another strength is the percentage
of women included, almost 40 percent," he said, "which a lot of other studies are not always able to achieve." In fact,
he said, some of the gender differences in the findings were notable.
"The odds ratio of alcoholic women making a suicidal attempt was 2.86," he said. "This means that an alcoholic woman
has almost a three-fold greater likelihood of attempting suicide than a male alcoholic. That's powerful. It also fits
well with the knowledge that women in the general population make more suicide attempts than men, even though men have
a higher completion rate."
Schuckit plans to continue with the investigation of suicidality among alcoholics in order to better understand and
prevent suicide attempts and completions among this subgroup. "The underlying theme of this paper," said Schuckit, "and
of the COGA studies in general, is that alcohol-dependent individuals who drink will likely have mood problems. Those that
drink a lot will have major problems." Co-authors of the Alcoholism: Clinical & Experimental Research paper included:
U.W. Preuss, T.L. Smith, G.P. Danko, K. Buckman, L. Bierut, K.K. Bucholz, M.N. Hesselbrock, V.M. Hesselbrock, and T. Reich
of the University of California San Diego, and the Veterans Affairs Medical Center. The study was funded by the National
Institute on Alcohol Abuse and Alcoholism and the Veterans Affairs Research Service.
At 2 years, cocaine babies suffer cognitive development effects Researchers also find tobacco has negative effects
on motor development CLEVELAND - Scientists know the effects of cocaine on the adult brain and cardiovascular systems.
Now there is a growing body of research documenting the effects of prenatal cocaine exposure on infants, which is raising
public health concerns about the long-term cognitive and developmental outcomes for these children.
A study published by Case Western Reserve University School of Medicine, MetroHealth Medical Center, and University
Hospitals of Cleveland researchers in the April 17 issue of the "Journal of the American Medical Association," "Cognitive
and Motor Outcomes of Cocaine-Exposed Infants," looks at how prenatal cocaine exposure affects child developmental outcomes.
The study was conducted by Lynn T. Singer, Ph.D., Robert Arendt, Ph.D., Sonia Minnes, Ph.D., Ann Salvator, M.S., and
H. Lester Kirchner, Ph.D., all of the CWRU School of Medicine, Department of Pediatrics; Kathleen Farkas, Ph.D., CWRU Mandel
School of Applied Social Sciences; and Robert Kliegman, M.D., Medical College of Wisconsin, Milwaukee, Wis.
CWRU researchers followed 415 cocaine-exposed infants born at MetroHealth Medical Center in Cleveland to determine
how prenatal cocaine exposure affects child developmental outcomes. They were compared to non-exposed infants on cognitive
and motor development until age 2. What they found, according to Singer, was that prenatal cocaine exposure does affect
a child's cognitive development, but not motor development. However, tobacco exposure had negative effects on motor
development.
There have been previous studies in this area, but their findings are contradictory. While some studies have found
generalized developmental delays in cocaine-exposed infants, other studies have not demonstrated differences or found
only subtle cognitive effects. Those studies, CWRU researchers say, are flawed for several reasons, including high dropout
rates, small sample sizes, ignored negative environmental factors, lack of biologic measures revealing exposure severity,
incorrect sample populations and outdated development scales.
This study is the first to document the negative effects on cognitive development in a scientifically rigorous manner.
Singer, professor of pediatrics and psychiatry, and interim provost and CWRU vice president, said the study was unique
because it had measures of both the mothers' self report of their drug use prenatally, as well as infant meconium, which
provided a physical measure of the amount of drug exposure. The study also controlled for many more factors in the environment
than prior studies, including stimulation levels in the home, mothers' vocabulary and mental health status and characteristics
of foster caregivers. The team used newly standardized versions of the major infancy development tests. And they were able
to maintain more than 90 percent of the participants during the study, and at two years, 100 percent of the sample had
at least one follow-up visit.
Mothers and infants were recruited between 1994 and 1996 from a high-risk population screened for drug use. Urine
samples were obtained immediately before or after labor and delivery, and analyzed for the presence of cocaine metabolites,
cannabinoids, opiates, PCP and amphetamines. Urine tests for drugs were performed by the hospital on all women who received
no prenatal care, appeared to be intoxicated or taking drugs, had a history with the Department of Human Services in
previous pregnancies, or self-admitted or appeared to be high risk for drug use after interview by hospital staff. Meconium
was collected in the hospital from infants' diapers and screened for drugs.
Researchers initially identified 647 mothers and infants for the study, excluding 232 for various reasons. Infants
were seen at the research laboratory at 6.5, 12 and 24 months and administered the widely used Bayley Mental and Motor
Scales of Infant Development (BSID II) standardized assessments. The scales assigned infants a standard score reflecting
memory, language and problem-solving abilities, as well as measurements of gross and fine motor control and coordination.
Researchers found that for all trimesters, cocaine-using women used alcohol, marijuana and tobacco more frequently
and in higher amounts than non-users. Cocaine-using women were found to be older, had more children and were less likely
to have had prenatal care. They also were less likely to be married; had lower vocabulary, block design and picture completion
scores; and higher psychological distress scores.
The study also found that cocaine-exposed infants had lower gestational age, birthweight, head circumference and length
than non-exposed infants. There were more preterm, low birthweight and small for gestational age infants in the exposed
group.
Researchers also found that the rate of mental retardation in cocaine-exposed children at age 2 (13.7 percent v. 7.1
percent in the non-exposed group) is 4.89 times higher than expected in the general population. And the percentage of
children with mild delays (37.6 percent in the exposed group v. 20.9 percent in the non-exposed group) requiring intervention
was almost double the rate of the high risk, non-cocaine group. Researchers speculate it is likely that these children
will continue to have learning problems and an increased need for special educational services at school age.
Another important note from the study is that cognitive delays could not be attributed to exposure to other drugs
or a large number of other variables, including inadequate prenatal care, caregiver or birth mother intelligence, psychological
distress, postnatal drug exposure or a low quality home environment.
Singer said the team is concerned that the study data will be misinterpreted and used to punish women or to remove
children from their families.
"Prosecution of women will not address the problems of alcohol and drug abuse," Singer said. "In fact, our study indicates
that tobacco exposure also has significant negative effects on infant development. Our findings also indicate that the
quality of stimulation and environmental intervention can have a large effect on children's mental development independent
of cocaine or other drug exposure."
About one million children have been born after fetal cocaine exposure since the mid-1980s, when the "crack epidemic"
emerged with the marketing of a cheap, potent, easily available, smokeable form of cocaine.
"We hope that this study will convince public policy and health providers that there needs to be a major emphasis
on the provision of drug treatment, including smoking cessation, and mental health services for women - especially poor
women who are currently underserved," Singer said. This study was supported by grants from the National Institute on Drug
Abuse and the General Clinical Research Center.
Parent's Depression Ups Kid's Risk of Anxiety Wed Apr 17, 6:19 PM ET NEW YORK (Reuters Health) - Having at least
one parent with major depression increases a child's risk for depression as well as substance abuse and anxiety disorders
in late adolescence and early adulthood, new study findings show. What's more, the child's depression is likely to be more
severe than the parent's, a team of German researchers report.
"This study has once more demonstrated that offspring of depressed parents constitute an important high-risk group,"
write lead study author Dr. Roselind Lieb, of the Max Planck Institute of Psychiatry in Munich, Germany and colleagues.
"Specifically, the early detection of mental health problems in offspring of depressed parents seems to be crucial,
as this would allow the treatment of early manifestation of mental problems before they cause clinical impairment,"
the authors add.
The study results are based on surveys of 2,427 German youth, aged 14 to 24 years, and their parents.
Forty-two percent of the mothers and 23% of the fathers were either diagnosed with major depression or experienced
at least one depressive episode, the investigators report in the April issue of Archives of General Psychiatry. For
one third of the study sample, only the mother had major depression, but for 16%, both parents were affected.
A follow-up survey, conducted 3.5 years after the initial survey, revealed that nearly one in five offspring had experienced
at least one episode of major depression and about 4% had symptoms of lifetime dysthymia--a milder, chronic form of
depression, Lieb and colleagues report. Those with at least one depressed parent had a roughly three-fold greater risk
of depression than their peers with non-affected parents.
Further, children of depressed parents had an earlier onset of depressive disorders and more severe depression than
children of nonaffected parents. They also reported having more depressive episodes, being more impaired in their social
and leisure activities and seeking more treatment for depression than did their peers, study findings indicate.
What's more, in addition to a higher rate of depressive disorders, children of depressed parents also had higher rates
of substance abuse and dependence disorders and anxiety disorders, such as obsessive-compulsive disorder, than did their
peers with nondepressed parents, the investigators report. Those with one depressed parent were generally at similar risk
for the various mental disorders to those with two depressed parents.
Overall, 43% of the youth reported having substance use disorders, including nicotine dependence and drug and alcohol
abuse and dependence, and 35% reported having anxiety disorders, study findings indicate. Those with at least one depressed
parent were reportedly 40% more likely to have a substance abuse disorder and 60% more likely to have an anxiety disorder
than individuals with nondepressed parents.
"Major depression in parents increases the overall risk in offspring for onset of depressive and other mental disorders
and influences patterns of the natural course of depression in the early stages of manifestation," the researchers conclude. SOURCE:
Archives of General Psychiatry 2002;59:365-374.
Treat addicts' mental illness Marilyn Elias USA TODAY Mental disorders are common among alcoholics and drug
abusers, but their mental illness and addictions are seldom treated at the same time, which prevents many from recovering
from either, says a report sent to Congress today.
And the government must take the lead in tearing down the ''firewall'' between programs that treat addiction and those
that treat mental illness, the report concludes.
People who have mental illness and are substance abusers have traditionally been considered exceptions, ''but it's
time to get real,'' says Charles Curie of the Substance Abuse and Mental Health Services Administration, which wrote
the report at Congress' request.
About one-third of drug and alcohol abusers have mental disorders, Curie says, and adults with mental illness are
three times more likely than others to be substance abusers. An estimated 7 million to 10 million Americans have mental
and addictive disorders, he says. There's strong evidence that integrated programs work best for them.
But that's going to take a major overhaul of the nation's treatment system. ''Virtually all programs are designed
for one or the other,'' says psychiatrist Kenneth Minkoff, a clinical professor at Harvard. People with both problems
''have poor outcomes at higher cost, and they're more likely to end up in the corrections system.''
A recent study of the Pennsylvania state prison system found that 85% of inmates had addictions, and half of them
had mental disorders as well. ''That's typical of prison systems nationally,'' Curie says. ''And we know if these inmates
recover from the disorders, they're unlikely to repeat crimes.''
In the past few years, states have started some model integrated programs, but the pace needs to quicken, he says.
The report lists several key steps the health services administration will take. Among them: * Federal financial
incentives that will spur states to try integrated programs.
* Incentives to combine therapy with medication in long-term treatment plans that help patients find employment and
housing.
* A national summit next year for consumer advocates and experts in treatment and criminal justice.
* A ''tool kit'' to help local agencies replicate excellent programs.
In Connecticut, a Yale study showed that heroin addicts were far more likely to drop out of methadone treatment if
they were depressed or had anxiety disorders. One-third of the state's methadone treatment programs have since added
psychiatric screenings and treatment. That has kept more clients in the program and off heroin, says psychologist Tom
Kirk, Connecticut's commissioner for mental health and addiction services.
''We have to change the programs to fit what people need, not try to fit the people into programs,'' he says. ''It's
better value because patients are more likely to recover.''
U.S. Pushes Heroin Addiction Treatment Associated Press - December 10, 2002 WASHINGTON (AP) - Federal health officials
launched an education campaign Tuesday to let doctors and heroin users know there's a new medication that can help curb
addicts' cravings - and for the first time, it can be prescribed in doctor's offices instead of drug-treatment clinics.
The Food and Drug Administration approved buprenorphine in October, an alternative to methadone in helping people
kick addiction to heroin and similar opioids, drugs also found in prescription painkillers.
Now, the Substance Abuse and Mental Health Services Administration is trying to spread the word.
Methadone is the most common treatment for opioid addiction, but it can be dispensed only in a few special drug-treatment
clinics. Only about 20 percent of heroin addicts receive it.
Buprenorphine, in contrast, can be prescribed in doctor's offices - as long as the physician qualifies. The key:
Doctors must seek a government waiver allowing them to prescribe buprenorphine after completing eight hours of mandatory
training.
So far, more than 2,000 doctors have been trained to use buprenorphine and about 300 have received waivers to begin
prescribing, according to SAMHSA.
To increase those numbers - and let addicts know about the new option - the drug abuse agency plans to hold public
meetings in Baltimore, Boston, Chicago, Dallas, Detroit, Miami, New Orleans, New York/Newark, N.J., Portland, Ore.,
Salt Lake City, San Francisco, Seattle, Wilmington, Del./Philadelphia and San Juan, Puerto Rico.
Buprenorphine, a tablet dissolved under the tongue, works by blocking the same brain receptors that heroin targets,
but without heroin's high and with weaker narcotic effects than methadone.
Survey: Drug Use by U.S. Teens Declines By SIOBHAN McDONOUGH, Associated Press Writer WASHINGTON - American
teenagers are cutting their use of illicit drugs, cigarettes and alcohol, said an annual survey for the government released
Monday.
The downside: A large number of young people still using drugs, said Lloyd D. Johnston, who directed the study by
the University of Michigan's Institute for Social Research.
"There's a smorgasbord of drugs that are out there," said Johnston. "Very few drugs leave the table, but there are
always new ones being discovered and put forward, like Ecstasy."
Ecstasy, also known as MDMA, is a synthetic drug considered part hallucinogen and part amphetamine that has been linked
to brain, heart and kidney damage. It became popular over the past decade at dance parties known as raves for the energy
and euphoria it gives users.
The survey of 8th-, 10th- and 12th-graders has been done for the Department of Health and Human Services (news - web
sites) for 28 years.
Results from the 2002 Monitoring the Future study showed more than half of 12th graders have used an illicit drug.
Thirty percent of 12th-graders have used some drug other than marijuana, and 11 percent have used Ecstasy.
Still, those figures are down from recent years. For example, Ecstasy use among 10th-graders in the past year declined
from 6.2 percent to 4.9 percent.
"As youngsters came to see it as more dangerous to use, they moved away from it," Johnston said. In 2002, 52 percent
of 12th-graders noted a great risk of harm associated with Ecstasy, up 14 percentage points from 2000 figures.
The survey, funded by the National Institute on Drug Abuse, tracked illicit drug use and attitudes among 44,000 students
from 394 schools.
Findings include: Percentages of 8th- and 10th-graders using any illicit drug declined and were at their lowest
level since 1993 and 1995, respectively.
Marijuana use decreased among 10th graders, and in the past year, the rate of use of 14.6 percent among 8th-graders
was the lowest level since 1994, and well below the recent peak of 18.3 percent in 1996. Roughly 30.3 percent of 10th
graders reported marijuana use in 2002, compared with 34.8 percent in 1997.
LSD use decreased significantly among 8th-, 10th- and 12th-graders. LSD use by 12th-graders reached the lowest point
in the last 28 years.
Use of cocaine and heroin remained stable.
Cigarette smoking decreased in each grade, expanding on a recent trend. There has been a 50 percent decline since
its peak year in 1996.
John Walters, director of the White House's Office of National Drug Control Policy, said the survey shows that drug
prevention efforts are working.
"Drug use by our young people is headed down to levels that we haven't seen in years," Walters said. "This is very
good news for communities across America." On the Net: www.whitehousedrugpolicy.gov
Cocaine harms brain's 'pleasure center,' addict study finds Drug attacks the very cells that allow users to feel
its effects Finding may aid understanding of addiction, depression, normal aging
ANN ARBOR, MI - New research results strongly suggest that cocaine bites the hand that feeds it, in essence, by harming
or even killing the very brain cells that trigger the "high" that cocaine users feel.
This first-ever direct finding of cocaine-induced damage to key cells in the human brain's dopamine "pleasure center"
may help explain many aspects of cocaine addiction, and perhaps aid the development of anti-addiction drugs. It also
could help scientists understand other disorders involving the same brain cells, including depression.
The results are the latest from research involving postmortem brain tissue samples from cocaine abusers and control
subjects, performed at the University of Michigan Health System and the VA Ann Arbor Healthcare System. The paper will
appear in the January issue of the American Journal of Psychiatry.
"This is the clearest evidence to date that the specific neurons cocaine interacts with don't like it and are disturbed
by the drug's effects," says Karley Little, M.D., associate professor of psychiatry at the U-M Medical School and chief
of the VAHS Affective Neuropharmacology Laboratory. "The questions we now face are: Are the cells dormant or damaged,
is the effect reversible or permanent, and is it preventable?"
Little and his colleagues report results from 35 known cocaine abusers and 35 non-drug users of about the same age,
sex, race and causes of death. Using brain samples normally removed during autopsy, the researchers measured several
indicators of the health of the subjects' dopamine brain cells, which release a pleasure-signaling chemical called dopamine.
The cells interact directly with cocaine.
The team looked at levels of a protein called VMAT2, as well as VMAT2's binding to a selective radiotracer molecule,
and overall dopamine level.
In all three, cocaine users' levels were significantly lower than control subjects. Levels tended to be lowest in
cocaine users with depression.
The paper gives the most conclusive evidence yet that dopamine neurons are harmed by cocaine use, because it uses
three molecular measures that provide a trustworthy assessment of dopamine neuron health.
Dopamine, Little explains, triggers the actions required to repeat previous pleasures. It's not only involved in drug
users' "high" - it helps drive us to eat, work, feel emotions, and reproduce. Normally, when something pleasurable happens,
dopamine neurons pump the chemical into the gaps between themselves and related brain cells. Dopamine finds its way
to receptors on neighboring cells, triggering signals that help set off pathways to different feelings or sensations.
Then, the dopamine is normally brought back into its home cell, entering through a gateway in the membrane called
a transporter. While our brain waits for another pleasurable stimulus - a good meal, a smile from a friend, a kiss -
dopamine lies waiting inside the neuron, sequestered in tiny packets called vesicles. VMAT2 acts as a pump to pull returning
dopamine into vesicles.
When it comes time for another dopamine release, the vesicles merge with the cell membrane, dumping their contents
into the gap, or synapse, and the pleasure signaling process begins again.
Dopamine neurons in the brain's pleasure center die off at a steady rate over a person's lifetime. Severe damage is
a hallmark of Parkinson's disease, causing its loss of movement control. "As the words themselves suggest, there's an
intimate connection between motion and emotion," says Little. "Emotion puts you in motion -- they're pre-activity preparations.
It's not surprising that the basal ganglia, where these dopamine neurons are, is very active in 'emotional states.'"
When first taken, cocaine has a disruptive effect on the brain's dopamine system: It blocks the transporters that
return dopamine to its home cell once its signaling job is done. With nowhere to go, dopamine builds up in the synapse
and keeps binding with other cells' receptors, sending pleasure signals over and over again. This helps cause the intense
"high" cocaine users feel.
Since the dopamine system helps us recognize pleasurable experiences and seek to repeat them, cocaine's long-term
dopamine effects likely contribute to the craving addicts feel, and the decreased motivation, stunted emotion and uncomfortable
withdrawal they face.
In recent years, many researchers have come to suspect that chronic cocaine use causes the brain to adapt to the drug's
presence by altering the molecules involved in dopamine release and reuptake, and in the genetic instructions needed
to make those molecules. Little and his colleagues are studying the effects of long-term cocaine use on the brain at
a molecular level, in an attempt to explain the effects seen in cocaine users and addicts.
In several studies, including the current one, they've used postmortem samples of brain tissue from known cocaine
users who were using the drug at the time of their deaths, and from well-matched control subjects. They focused in on
the striatum, an area of the brain with the highest concentration of dopamine neurons.
With approval from the U-M Institutional Review Board and appropriate consent, they interviewed relatives and friends
of the subjects, and asked about the subjects' alcohol use, mental illness and other characteristics.
The team previously showed that cocaine users have higher numbers of dopamine transporters, suggesting that the cells
tried to make more return gateways to compensate for blocked ones. Recently, they showed in cell cultures that cocaine
causes more dopamine transporters to travel from the interior of a cell to the membrane, increasing the overall dopamine
uptake level.
The data provide support for the idea that chronic cocaine abuse leads to a phenomenon seen in animals, called allostasis
of reward. With extended use of cocaine, the brain's response to the drug is "reset", and drug-taking once pursued for
the pleasure it caused becomes drug-taking to avoid the negative feelings associated with the absence of cocaine.
The new data suggest this same phenomenon occurs in human cocaine users, and is quite pronounced at the neurochemical
level. The experiment sheds light on the molecular mechanisms involved as dopamine-producing brain cells try to adapt
to a cocaine-drenched environment.
VMAT2 protein levels, measured through the use of specific antibodies that bind to the protein, are not as affected
by other factors as dopamine transporters are. VMAT2 binding availability, measured through a unique radioactive tracer
developed by U-M nuclear medicine specialists, is another assessment of VMAT2 presence and activity. And the overall
dopamine level, measured through liquid chromatography, shows how much of the chemical was available at the time of
death.
On the whole, all three were significantly lower in cocaine users than in non-drug users. A history of alcohol abuse
in cocaine users or controls did not affect the difference significantly.
Levels of VMAT2 protein were lowest in the seven cocaine users with mood disorders that may have been caused by cocaine
use. Researchers have found that depressed cocaine users have more severe addiction and mental health problems than
non-depressed users. Little hypothesizes that the decreased dopamine vesicles and increased transporters may contribute
to cocaine-induced depression and other depressive disorders. This may explain why depressed cocaine users are less
likely to respond to some depression treatments.
In all, Little says, "We could be seeing the result of the brain's attempt to regulate the dopamine system in response
to cocaine use, to try to reduce the amount of dopamine that's released by reducing the ability to collect it in vesicles.
But we could also be seeing real damage or death to dopamine neurons. Either way, this highlights the fragility of these
neurons and shows the vicious cycle that cocaine use can create." New treatments will have to break that cycle, he adds,
and the new findings may help steer clinical researchers.
He also emphasizes that the vulnerable nature of dopamine neurons is important in understanding the moods and actions
of normal adults as they age and lose dopamine neurons naturally. Considerable evidence suggests that uncontained dopamine
may be mildly toxic over time.
In future research, Little and his colleagues hope to look for differences in the number of dopamine neurons in the
subjects' brain samples, and to study gene activity in the cells of cocaine users and control subjects. They also hope
their results will help other researchers study living cocaine users and look for signs of decreased VMAT2 levels. ###
In addition to Little, the study's authors are David Krolewski, M.S.; Lian Zhang, Ph.D.; and Bader Cassin, M.D. U-M
nuclear medicine researcher Kirk Frey, M.D., led the team that developed the radioactive tracer used to measure VMAT2
binding levels. The study was funded by the National Institute on Drug Abuse of the National Institutes of Health, and
by a VA Merit Award. Reference: American Journal of Psychiatry 160:1-9, January 2003.
Teen drug use associated with psychiatric disorders later in life Children who start to use alcohol, marijuana
or other illicit drugs in their early teen years are more likely to experience psychiatric disorders, especially depression,
in their late 20's.
Although teens who started smoking at an early age were at increased risk for alcohol dependence and substance use
disorders in their late 20's, they did not appear to be at an increased risk for depression or other psychiatric disorders.
However, initiating tobacco use in late adolescence was associated with depression and other psychiatric disorders in
the late 20s.
These findings are based on a 22-year study that tracked the self-reported substance abuse and health histories of
736 youths through their early-and mid-teen years into early adulthood. Scientists from the Mount Sinai School of Medicine
and Columbia University started collecting data on the children in 1975, when the subjects were one through 10 years
of age. Four follow-up interviews were conducted: in 1983, 1986, 1992, and 1997, when the average ages of the subjects
were 14, 16, 22, and 27 years.
During mid to late adolescence, 18.8 percent of the subjects reported moderate to heavy tobacco use; 6.2 percent reported
moderate to heavy alcohol use; 17.6 percent reported moderate to heavy marijuana use; and 3.4 percent reported moderate
to heavy use of other illicit drugs. During young adulthood, these percentages increased to 35.4, 13.0, 18.4, and 3.7,
respectively.
In 1997, when the subjects were in their late 20s, 8.3 percent qualified for a diagnosis of a major depressive disorder
(MDD), 5.2 percent were alcohol dependent, and 6.1 percent had a substance use disorder. Heavy alcohol, marijuana, and
other illicit drug use were significantly related to later psychiatric disorders. About 85 percent of the individuals
diagnosed with MDD in their late 20s had used marijuana when they were younger and more than 66 percent had a prior
history of alcohol and/or other illicit drug use.
WHAT IT MEANS: This study adds to the growing body of knowledge about the complex relationship between drug abuse
and psychiatric disorders. Such findings will be useful in efforts to develop more effective prevention and treatment
interventions for individuals at risk for these co-occurring conditions. Dr. David Brook and colleagues published the
study, which was supported by the National Institute on Drug Abuse, in the November, 2002 issue of the Archives of General
Psychiatry.
Study finds 1,400 college student deaths annually related to alcohol Associated Press - April 09, 2002 WASHINGTON
(AP) - An estimated 1,400 college students are killed every year in alcohol-related accidents, according to a study
released Tuesday that researchers call the most comprehensive look ever at the consequences of student drinking.
The researchers say the figures show that college drinking needs to seen as a major health concern.
``Historically, I think there has been the view that whatever college students are doing, it's not that serious a
problem, it's a rite of passage,'' said Kenneth J. Sher, a psychology professor at the University of Missouri-Columbia.
The study by the federally supported Task Force on College Drinking estimated that drinking by college students contributes
to 500,000 injuries and 70,000 cases of sexual assault or date rape. Also, 400,000 students between 18 and 24 years
old reported having had unprotected sex as a result of drinking.
The study does not say whether the problems are increasing or decreasing. A Harvard School of Public Health survey
released last month reported that more students are abstaining from alcohol, but levels of binge drinking - having at
least four or five drinks at a sitting - are the same as in the early 1990s.
The new report was one of 24 studies commissioned by the task force of college presidents, scientists and students
convened by the National Institute on Alcohol Abuse and Alcoholism. The institute is part of the National Institutes
of Health.
Most of the papers will be published in the forthcoming March issue of the Journal of Studies on Alcohol.
Researchers integrated various databases and survey results to reach their findings.
Motor vehicle fatalities were the most common form of alcohol-related deaths. The statistics included college students
killed in car accidents if the students had alcohol in their blood, even if the level was below the legal limit.
Students who died in other alcohol-related accidents, such as falls and drownings, were included. Those who died as
a result of homicides or suicides were not.
Chief researcher Ralph Hingson of the Boston University School of Public Health said he believes the estimates are
more likely to be too conservative than overstated.
``I think actually getting the numbers out will help the public understand that this is a very large problem, perhaps
a larger problem than people might have otherwise thought,'' he said.
Overdoses and Deaths From Abuse of Drug Methadone Are Up By PAM BELLUCK PORTLAND, Me. - Methadone, a drug long
valued for treating heroin addiction and for soothing chronic pain, is increasingly being abused by recreational drug
users and is causing an alarming increase in overdoses and deaths, federal and state officials say.
In Florida, methadone-related deaths jumped from 209 in 2000 to 357 in 2001 to 254 in just the first six months of
2002, the latest period for which data are available.
"Out of noplace came methadone," said James McDonough, director of the Florida Office of Drug Control. "It now is
the fastest rising killer drug."
In North Carolina, deaths caused by methadone increased eightfold, to 58 in 2001 from 7 in 1997 - an "absolutely amazing"
jump, said Catherine Sanford, a state epidemiologist.
In Maine, methadone was the drug found most frequently in people who died of overdoses from 1997 to 2002. It was found
in almost a quarter of the deaths. In the first six months of last year, methadone killed 18 people in Maine, up from
4 in all of 1997. Dr. John H. Burton, medical director for Maine Emergency Medical Services, said hospital emergency
rooms were seeing "a tidal wave" of methadone-related cases.
The increase in methadone overdoses and deaths has floored many drug experts because methadone, which does not provide
a quick or potent high, has long been considered an unlikely candidate for substance abuse. It can be hours before a
user feels any effect, and it works more like a sedative than a stimulant.
And because methadone is considered such an important and affordable tool for treating addiction and pain, health
and law enforcement officials are facing a quandary: how to stop methadone abuse without curtailing its valuable uses
- and especially without driving addicts back to drugs like heroin.
"We've got years of experience with methadone and suddenly we've got this problem," said Dr. H. Westley Clark, director
of the federal Center for Substance Abuse Treatment. "We realize that lives are being lost and we're trying to stop
that. But we're trying not to do quick fixes that will cause us more problems."
The surge in methadone abuse appears linked to several factors, including the growing abuse of heroin and OxyContin,
a powerfully addictive prescription painkiller. Health and law enforcement officials are reporting that some of these
addicts are turning to methadone when they cannot get the other drugs.
At the same time, methadone has become more available. Physicians are increasingly prescribing it for pain relief,
in part because law enforcement officials have been cracking down on OxyContin, and more methadone clinics have sprung
up to treat the growing number of heroin addicts.
"The availability of methadone for treatment and pain has put people who would not normally be in a position to divert
drugs in that position," said Sgt. Scott J. Pelletier, who works for the Maine Drug Enforcement Agency handling drug
cases in Portland and Cumberland County, where methadone caused at least 30 deaths in 2002, according to the state medical
examiner's office.
University of Illinois at Chicago Alcohol dependence linked to chemical deficit Anxiety has long been linked to
substance abuse. It is the key psychological factor driving the impulse to drink alcohol and one of the first symptoms
of alcohol withdrawal.
Now, researchers at the University of Illinois at Chicago have discovered they can control the urge to drink in experimental
animals by manipulating the molecular events in the brain that underlie anxiety.
The study is published in the current issue of Alcoholism: Clinical and Experimental Research, the nation's premier
journal covering substance abuse.
The researchers found that a particular protein in the amygdala -- the area of the brain associated with emotion,
fear and anxiety -- controlled the drinking behavior of laboratory animals.
Rats that were chronically fed alcohol showed high levels of anxiety when alcohol was withdrawn from their diet.
In the early phases of withdrawal, levels of the active form of a protein called CREB were low in certain areas of
the amygdala.
However, when alcohol was present in the bloodstream, or when normal levels of active CREB were restored experimentally,
anxiety behaviors in the alcohol-dependent animals vanished.
"Some 30 to 70 percent of alcoholics are reported to suffer from anxiety, and depression -- drinking is a way for
these individuals to self-medicate," said Subhash Pandey, associate professor of psychiatry and director of neuroscience
alcoholism research at UIC. "If we can control the psychological symptoms, perhaps we can help many of the millions
of Americans who are victims of alcohol addiction."
CREB, or cyclic AMP responsive element binding protein, when activated, regulates the manufacture of a brain protein
called neuropeptide Y. Low levels of active CREB or of neuropeptide Y correlated with symptoms of anxiety and excessive
alcohol consumption, the scientists found.
In normal rats, the researchers blocked production of neuropeptide Y. With lower levels of neuropeptide Y, the animals
showed signs of anxiety and their alcohol consumption increased. When levels of neuropeptide Y were restored by infusing
it into the central amygdala, the rats' excessive drinking behavior ceased. ###
The UIC study was supported by the Department of Veterans Affairs and the National Institute on Alcohol Abuse and
Alcoholism.
According to NIAAA, an estimated 18 million Americans suffer from alcohol problems. Alcohol and drug abuse cost the
economy roughly $276 billion per year.
Other researchers involved in the UIC study were Adip Roy and Huaibo Zhang, postdoctoral research associates in psychiatry.
Study Finds Link Between Early Pot Use and Lasting Cognitive Deficits - But Is Pot Itself the Culprit? AScribe
Newswire - April 01, 2003 BELMONT, Mass., April 1 (AScribe Newswire) -- A new study in the latest issue of Drug and Alcohol
Dependence indicates an association between early use of cannabis (marijuana) and persisting cognitive deficits.
Led by Harrison Pope, Jr., MD, director of the Biological Psychiatry Laboratory at McLean Hospital, the researchers,
from McLean and the National Institute on Drug Abuse (NIDA), compared 122 heavy users of cannabis with 87 minimally
exposed control subjects. The 122 heavy users had smoked a median of about 15,000 separate times in their lives; the control
subjects had smoked a median of only 10 times.
Among the 122 cannabis users, 69 began smoking the drug before age 17 (early-onset group) and 53 began after age
17 (late-onset group). At the time of the neuropsychological assessments, all cannabis use had stopped for at least
28 days.
The authors found that early-onset cannabis users exhibited poorer cognitive performance than late-onset users and
control subjects. Statistical analyses, which adjusted for age, gender, ethnicity and family variables, indicated that
early-onset users differed significantly from late-onset users and control subjects on several measures of cognitive function,
most notably in verbal IQ. After adjusting for verbal IQ, however, virtually all of the differences between the early-onset
users and the late-onset users disappeared. These results suggest that a combination of social and/or biological factors
may lead to an association between early use of cannabis and deficits in verbal cognition.
The authors offer three competing explanations for these findings: 1) Cannabis might have a toxic effect on the developing
brain of young users; 2) People who begin smoking cannabis at a young age may have lower cognitive abilities initially,
before they ever tried cannabis; or 3) Young-onset cannabis users may not learn the cognitive skills required for the
tests, as they acquire less education and have less familiarity with mainstream culture.
"Any single explanation, or combination of the three, might fit the facts of the study," said Pope.
"Our results show how difficult it is to disentangle the causes of cannabis-associated cognitive deficits."
Co-authors of the study include Amanda Gruber, MD, James I. Hudson, MD, ScD, Geoffrey Cohane, BA and Deborah Yurgelun-Todd,
PhD, from the Biological Psychiatry Laboratory and Cognitive Neuroimaging Laboratory of McLean Hospital, and Marilyn
Heustis, PhD, from the Intramural Research Program at NIDA.
Brain Signal Prompts Addictive Behavior United Press International - April 09, 2003 Apr 09, 2003 (United Press
International via COMTEX) -- Using state-of-the-art technology, researchers for the first time have measured, to the
split-second, the chemical trigger that makes it difficult for addicts to just say, "No," to drugs, food, sex or other
over-indulgences.
The advance, accomplished by a team of psychologists, neuroscientists and chemists from the University of North Carolina
at Chapel Hill, could pave the way toward novel treatments for habits that exact a heavy price, in health as well
as dollars, investigators told United Press International.
"Our findings are extremely significant because we have identified a dynamic signal in the brain that is highly influential
on drug-taking," said Paul Phillips, research assistant professor of psychology. "Identifying signaling mechanisms
that drive drug-taking provides potential targets for therapeutic intervention."
Due to a lack of standardized classification methods, global addiction statistics are hard to come by, but officials
attest to their epidemic proportions.
For example, the United Nations International Drug Control Program estimates marijuana alone has 141 million users
worldwide. In the United States, a 2001 survey showed some 15.9 million Americans 12 or older partook of illicit drugs.
The Substance Abuse and Mental Health Service Administration blamed the practice for 601,776 hospital emergency department
visits that year.
The U.S. Department of Health and Human Services has implicated drug and alcohol overuse in the death of more than
120,000 Americans each year and in an annual bill totaling more than $294 billion in health care, lost productivity
and other related costs.
In their rat study, detailed in the April 10 issue of the British journal Nature, the scientists offer a much-anticipated
solution to a "chicken-and-egg" puzzle of neurochemical cause and effect in addiction. They identify the key player
as dopamine, the chemical that transports directives from the brain to other parts of the body.
Dopamine is known to increase in levels during addictive behaviors, such as eating, taking drugs or having sex. Experiments
revealed the brain releases the substance before as well as during pleasurable acts. Because the nervous systems of
both rats and humans are similar when stimulated, scientists said they expect the rat results to apply to human research.
In a critical difference from past surveys -- which gave a minute-by-minute account of brain processes underlying
addiction -- the new research presents information about what happens over fractions of a second.
"The problem with previous methods is that they did not provide enough resolution to determine if dopamine release
occurs before drug seeking is triggered," said David Self, associate professor of psychiatry and Lydia Bryant Test
professor at the University of Texas Southwestern Medical Center in Dallas, who analyzed the findings.
"The implications of this study are that split-second dopamine changes are sufficient to influence drug-taking behavior,"
Phillips told UPI.
The high-tech investigation was made possible by a cutting-edge electrochemical technique called fast-scan cyclic
voltammetry, pioneered by Mark Wightman, Kenan professor of chemistry and neuroscience at UT Southwestern.
"Without the advances in his lab and his expertise, this project would have been technically unfeasible," Phillips
emphasized.
Phillips, Wightman, Regina Carelli, Garret Stuber and Michael Heien monitored the release of dopamine over amazingly
brief, 100-millisecond intervals -- about one-third the time the eye takes to blink and some 200 times faster than
has ever been done before.
Working with rats trained to press a lever to receive a cocaine "reward," the team found the chemical trigger both
precedes and proceeds from the pursuit of gratification.
The researchers measured dopamine release in the nucleus accumbens, a brain region implicated in functions ranging
from motivation and reward to feeding and drug addiction. They observed a brief dopamine burst seconds before the animals
approached the lever. In rodents taught to associate a flash of light and a tone with a forthcoming "hit," the audiovisual
cue itself was sufficient to get the dopamine flowing.
"Our work indicates that just the anticipation of receiving cocaine may cause significant increases in dopamine levels
that may control drug-taking behaviors," said Carelli, associate professor of psychology.
The dopamine levels continued to rise as the rodents closed in on the lever and pressed, peaking just after the animals
got their "fix." No such rise in dopamine level was detected in control animals not trained to get cocaine on demand,
Phillips said.
"As a rat chases its tail, drug addicts may suffer a similar vicious circle of priming and reward controlled by these
dopamine signals," Self explained. "Therapies aimed at preventing one or both of these dopamine signals could be effective
treatments for addiction."
The irresistibility of the signals' effect is exemplified by the inability of food addicts to stop with just one
bite, scientists said.
"Chocolate lovers whose cravings are strongly enhanced by tasting just a small morsel often experience this priming
effect," Self told UPI. "The initial taste whets the appetite for more, explaining the brief shelf life of an open
chocolate box."
In suggesting the same chemical that produces euphoria with cocaine also can trigger yearning for the drug, the study
raises the prospect of new treatments, scientists said.
"Pharmacological or behavioral treatments that blunt this dopamine pulse, without completely blocking all dopamine
function, could be one way to prevent drug craving," Self said.
The research was funded by the National Institute on Drug Abuse.
NIH/National Institute on Drug Abuse Study of twins reveals changes in attention and motor skills after heavy
stimulant abuse
In a study supported by the National Institute on Drug Abuse (NIDA), researchers found that heavy stimulant abuse
can result in changes in attention and motor skills that can persist for at least a year.
The investigators studied 50 pairs of twins; in each pair, one twin had a history of abusing cocaine and/or methamphetamine
and the other had no history of drug abuse. Thirty-one monozygotic (identical) and 19 dizygotic (fraternal) adult
male twin pairs were tested for attention and motor skills, executive functioning, intelligence, and memory at least one
year after the drug-using twin's last-reported use of stimulants.
The researchers, led by Dr. Rosemary Toomey from Massachusetts General Hospital, found that the twin with a history
of stimulant abuse performed significantly worse on several tests of attention and motor skills than did the sibling
who had never used drugs.
However, abusers outperformed their non-drug-using twin on visual vigilance, a test measuring the ability to pay
attention over time.
WHAT IT MEANS: This study provides evidence that stimulant abuse can result in long-term residual neuropsychological
effects.
The study was published in the March 2003 issue of the journal Archives of General Psychiatry.
Alcohol-induced blackouts may lead to heavier drinking 21:00 14 April 03 NewScientist.com news service Partial
memory blackouts after drinking binges could contribute to future alcoholism, say researchers, because drinkers may fill
in the blanks with rosy memories.
Experiments involving moderate alcohol intake showed that drinkers who had previously suffered partial memory loss
had poorer memories than drinkers who had not. Questionnaires also revealed that the memory loss drinkers also had more
optimistic attitudes about the effect alcohol had upon them.
These results, and others from the same study, led the scientists at the University of Texas in Austin to conclude
that drinkers experiencing "fragmentary blackouts" are more likely to misremember drinking experiences and then fill
in the gaps with positive beliefs. And this would increase the likelihood of them drinking heavily in the future, the
researchers say.
Psychologist William Corbin, one of the team, notes that unlike total blackouts, drinkers experiencing fragmentary
blackouts could remember some things when prompted by cues. He told New Scientist that these people's beliefs about
their lost time are "unrealistically positive". For example, they believe alcohol makes them more sociable, sexually
attractive or assertive, he says.
Corbin believes blackouts should be given more weight as an early warning sign of future alcohol problems. "It could
identify people more at risk."
Non-alcoholic placebo
The team examined 108 college students who were weekly binge drinkers. Half had experienced fragmentary blackouts
(FB) in the previous year, half had not.
When given three alcoholic drinks, FB students showed worse memory both during and just after intoxication. However,
there was no difference when the drinks were non-alcoholic placebos.
"In the absence of alcohol, the memory ability of those who report fragmentary blackouts does not appear to be any
different from those who do not experience these phenomena," says Kim Fromme, a psychologist at the University of Texas.
"Yet when they drink alcohol, people who experience fragmentary blackouts show poorer memory performance."
Fromme adds: "If you already believe alcohol has primarily positive effects, and you cannot recall what happened after
a drinking episode, you are likely to assume that the outcome was positive."
"We are very worried about binge drinking," says Anne Jenkins, a spokeswoman for the UK's Alcohol Concern. "There's
an assumption that the harmful effects are only immediate, but some studies are beginning to suggest that regular binge
drinking can have long term health effects."
One adult in 13 is dependent on alcohol and 33,000 people die each year due to alcohol-related incidents or associated
health problems according to UK government statistics. Journal reference: Alcoholism: Clinical and Experimental Research (vol
27, p 628)
Heroin Use Higher in New Jersey's Suburbs, Rural Areas
Does Data Reflect National Trend?
By Jeanie Davis
WebMD Medical News
May 17, 2001 -- Injection drug use has declined steadily in America's inner cities, but New Jersey's public health
officials have detected a disturbing new trend. Since 1993, the use of injectable heroin and cocaine has increased
-- raising concerns about spread of HIV and other infections.
And the increased use was in young adults outside the urban areas -- a group not previously thought to be at high
risk, says the new CDC study.
"We found an increase in injection heroin use in younger age groups -- 18 to 25 -- in all ethnic groups across the
state," says lead author Anna Kline, PhD, director of research in the division of addiction services of the New Jersey
Department of Health. "We also noticed an expansion into the suburbs and rural areas."
In her study, Klein looked at data on persons admitted to New Jersey addiction outpatient treatment centers who
reported using injectable drugs from 1992 to 1999. She also analyzed data on users of injectable heroin and cocaine
from 1980 to the early 1990s. The numbers of injectable users declined from the 1980s through the early 1990s, says
Kline.
In 1995 the trend shifted, with 43% of patients reporting use in 1993 compared with 45% in 1999. The largest increases
were among those 18 to 25 years old, says Kline. That number rose from 22% in 1993 to 46% in 1999.
Total numbers of injectable drug users increased substantially among suburban/rural residents from 1993 to 1999
while it declined among urban residents.
"Quite bluntly, that can't be good news," says George DiFerdinando, MD, deputy commissioner for the New Jersey Department
of Health and Senior Services. DiFerdinando is a co-author of the CDC study.
But can local drug use patterns give an idea of what's going on nationally?
"Not really," says DiFerdinando. "To a surprising extent, drug use patterns can be very local or even regional. Methamphetamine
is extremely popular in other parts of the country, but we haven't had too much of that problem in New Jersey. We have
a substantial problem with ecstasy while some parts of country don't."
It's the age group that he's most concerned about, DiFerdinando tells WebMD.
"We see it in this study and others -- high-risk behaviors in the 18- to 25-year-old group have greatly increased.
The message isn't getting through. We have to keep pushing the prevention message with the same intensity that we
did at the beginning of the HIV epidemic 15 years ago. It was a crisis atmosphere, and we felt we had to do everything
possible."
Not all experts agree with the CDC data. In fact, national studies show that since 1995 heroin use in young adults
-- 19- to 29-year-olds -- has remained "amazingly constant," says Lloyd Johnston, PhD, principal investigator of the
Monitoring the Future study from the University of Michigan Institute for Social Research. His studies are funded
by grants from the National Institute on Drug Abuse, an arm of the National Institutes of Health.
Johnston has tracked drug use for the past 25 years among adolescents, college students, and young adults across the
country, Johnston tells WebMD.
"We're quite good at looking at the nation as a whole," says Johnston. "We don't show any change since 1995 in heroin
use in young adults -- 19- to 29-year-olds. But our data is of high school graduates -- some 85% of the population.
The other 15% may be the heavier heroin users. Our absolute estimates are undoubtedly low, but I think we're picking
up the trends. And I don't see any trends of that sort."
Another major source -- the National Household Survey on Drug Abuse -- also shows no increase in heroin use among
the 18 to 25 age group, says Johnston. "In fact, they show a decrease in that population."
Main message from her study, says Kline: "The need for a redirection of prevention efforts," she tells WebMD. "We
have been placing a lot of preventive dollars for HIV/AIDS into the urban areas and not so much into the suburbs."
Also, the message needs to target younger kids, says Howard Simon, spokesperson for Partnership for a Drug-Free America.
"If you're talking about 18- to 25-year-olds, you're not talking about new drug users. They've probably been using
for a while. We like to look at the next group coming up, the 12- to 17-year-olds."
Too true, says Maggie Jenkins, director of Mainstream Kansas City Inc., a drug treatment facility for women in Johnson
County, Kan.
"I've had 13-, 14-, 15-year-old girls with [skin and muscle] infection ... from a dirty needle," Jenkins tells WebMD.
"They have to have the muscle in their arm removed; they go through hell with that. We need to get the message to them
better. Kids just haven't gotten the message about sharing dirty needles. They figure if they both use same needle,
then it's a clean needle. It's still a dirty needle."
What Do We Want? Rewards! When Do We Want 'Em? Now!
Instant Gratification, Addictive Behaviors May Lie in Specific Brain Area
By Neil Osterweil
WebMD Medical News
May 25, 2001 -- Good things may come to those who wait, but people who act impulsively simply can't wait for
their rewards, and settle for whatever they can get NOW. A new study suggests that impulsive behavior -- a feature
of addictions, attention-deficit hyperactivity disorder, and some personality disorders, may be caused by a brain
defect.
In the study, reported in the May 25 issue of the journal Science, rats trained to understand that they can
have one sugar pellet now or four later soon catch on to the idea that waiting can bring sweet rewards.
But when the same rats have damage to an area of the brain called the nucleus accumbens, they appear to lose
their ability to make wise choices and always go for the quick and easy fix, something like look-before-you-leap behavior, report
Rudolf Cardinal, PhD, and colleagues in the department of experimental psychology at the University of Cambridge, England.
A naturally-occurring substance called dopamine may help explain this phenomenon. Dopamine is one of the chemicals
that allow communication between nerves in the brain. It is also known to be involved in the sensation of reward
we experience from something we enjoy. Cardinal tells WebMD it's been known for a long time that natural rewards, like
food and sex, as well as artificial ones, like nicotine and cocaine, act on dopamine to activate the nucleus accumbens.
The conclusion that the nucleus accumbens is at the center of our reward system is bolstered by a second study
published in the May issue of the journal Neuron. In it, researchers report that the regions of the brain -- including
the nucleus accumbens -- that become activated in the anticipation and experience of winning at gambling, in a sense
another type of addictive, impulsive behavior, are the same regions that appear to respond in cocaine addicts.
Hans Breiter, PhD, co-director of the Motivation and Emotion Neuroscience Center in the department of radiology
at Massachusetts General Hospital, and colleagues used a high-power, real-time brain imager to look at brain activity
in 12 men taking part in a computer-controlled game of chance.
The subjects were given a $50 stake and were told that they could lose some or all of it, keep it, or increase
it. The volunteers were first shown how much they could win by watching where the spinner landed on a wheel-of-fortune;
this part of the test was called the expectancy phase. In the second or "outcome" phase, participants found whether
they had actually lost or won.
The researchers found that as the prospect of winning more money increased, so did activity in the parts of
the brain previously seen to respond to other types of rewards, such as drugs. The level of activity in the nucleus accumbens
and two other nearby regions grew as the potential jackpot increased in the expectancy phase, and similar changes were
seen during the outcome phase.
A researcher who has studied the genetics of addictive behaviors tells WebMD that certain people have genetic
abnormalities in their reward systems. The nucleus accumbens, he says, sits at the center of the reward system when
it's stimulated by gambling. Defects in this system, "can lead not only to potential problems with addictive behaviors
but with impulsivity in general," like that which occurs in attention-deficit hyperactivity disorder, says David
Comings, MD, director of medical genetics at City of Hope Medical Center in Duarte, Calif.
Comings points out that the drug Zyban, which is sometimes prescribed to help people quit smoking, is an antidepressant
that acts on dopamine in the brain, and that Ritalin, widely prescribed for children with ADHD, also acts to normalize
dopamine levels. These observations are suggestive of an underlying defect common to addiction, ADHD and other forms
of impulsive behavior.
CHOLECYSTOKININ PEPTIDE FRAGMENT TREATS ALCOHOLISM IN RATS Injecting rats with a four-amino acid peptide restores
the cholecystokinine system in the frontal cerebral cortex and hypothalamus after it has been deregulated by chronic
alcohol consumption, Russian researchers have shown.
Why Kicking the Cocaine Habit Is So Difficult
By Patricia Reaney
LONDON (Reuters) - Cocaine addicts may have such a tough time kicking the habit because cravings for the drug increase
long after they have stopped taking it, scientists said Wednesday.
Instead of gradually diminishing with time, an animal study showed that longings for the popular recreational drug
get worse with time and increase the likelihood of a relapse.
The findings by scientists at the National Institute on Drug Abuse (NIDA) in the United States could offer new
insights into how to help addicts who have repeatedly tried but failed to give up cocaine.
``This phenomenon helps explain why addiction is a chronic, relapsing disease,'' Dr. Alan Leshner, the director
of the NIDA, said in a statement.
``Craving is a powerful force for cocaine addicts to resist, and the finding that it persists long after last drug
use must be considered in tailoring treatment programs,'' he added.
NIDA scientists studied the impact of cocaine withdrawal and relapse on rats over periods ranging from a few days
to two months.
They noticed the first evidence of craving in the animals after about a week without the drug. The longings grew
over time and were the strongest at two months, the maximum length of the study.
Dr. Jeff Grimm, an experimental psychologist who led the research team, and his colleagues said that although the
research was limited to rats, it has implications for human addiction.
``If you look at relapse rates over time you tend to see that addicts relapse even after years of abstinence so
something is persisting that is calling people back to the drug after time,'' he said in a telephone interview.
``What we are seeing with the rats is that instead of immediately following the cessation of the drug the cravings
become stronger over time.''
The scientists said they know the underlying mechanism which causes the cravings but they suspect changes in the
brain over time could contribute to the phenomenon.
Grimm said the cravings in the rats were also linked to drug-associated environmental cues, similar to what has been shown
in drug addicts.
In the experiments the scientists trained the rats to press a lever to receive intravenous cocaine injections.
Afterward they tested the animals to determine if they would press the lever even if they no longer received the
cocaine.
Their research is published in the science journal Nature.
Drug addicts also have environmental cues, such as the sight of a syringe or other paraphernalia, that they associate
with the drug and which could trigger a relapse.
Drug Treatment Programs Can Work for Teens
By Suzanne Rostler
NEW YORK (Reuters Health) - Drug treatment programs designed to meet the specific needs of adolescents can reduce
rates of drug use and crime and improve academic performance among this group, results of a study report.
According to Dr. Christine E. Grella, a study author, these types of programs are relatively new. Prior to the
late 1980s, she said, young drug abusers were treated with adults.
``Adolescents entering drug programs have very different issues than adults,'' said Grella, an associate research
psychologist at the University of California in Los Angeles.
For example, younger drug abusers are more likely to use marijuana and alcohol while adults are more likely to
use cocaine and hallucinogenics, she said. Adolescents have developmental issues as they attempt to separate from
their families, she added, and they may be dealing with mental health disorders or physical and sexual abuse at
home.
Indeed, the study in the July issue of the Archives of General Psychiatry reports that about 63% suffered from mental
disorders such as depression or attention deficit hyperactivity disorder, and about 58% had legal problems.
``If they only get drug counseling and don't get their other needs met, they are more likely to return to treatment,''
Grella told Reuters Health.
The study included more than 1,100 adolescents aged 11-18 years, who were enrolled in 23 treatment programs in
four US cities. According to results, nearly 44% reported using marijuana weekly one year after treatment, compared
with more than 80% at the outset. Similarly, about 20% reported drinking heavily a year later, versus more than 34%
initially.
Just over half--53%--were involved in criminal activity after completing drug treatment programs compared with 76%
in the year before treatment. Patients also reported better grades in school, less hostility, fewer suicidal thoughts
and improved self-esteem after they underwent treatment.
However, patients who used hallucinogenic drugs and stimulants such as cocaine were less likely to improve.
The study also found that success was more likely to occur when treatment lasted longer, regardless of the severity
of the problem or the type of program. Individuals who remained in treatment longer were less likely to use drugs
or get arrested, for instance.
According to the study, the findings highlight ways in which treatments programs can be improved and underscore the
importance of addressing other problems. However, there are not enough treatment programs to meet the needs of
adolescents, Grella said.
In the study, treatment programs included residential programs in which patients lived at the facility and attended
counseling sessions, outpatient programs in which adolescents attended intensive day treatment, and short-term inpatient
programs that provided counseling sessions and lasted up to 35 days.
SOURCE: Archives of General Psychiatry 2001; 58: 689-695.
Drug Use Rises Among High School Students Father-Only Households Least Likely to Keep Kids Off Drugs By Sean
Martin WebMD Medical News July 19, 2001 (Washington) -- Drug use is on the rise among high school students after
several years of declining use, according to new results from an annual survey used to help guide the nation's drug
control policies.
According to the Pride survey, high school students (grades 9-12) reported higher use of marijuana, uppers, downers,
hallucinogens, and heroin compared with last year's study.
Doug Hall, spokesman for Pride, says, "We are finding a really tough nut to crack among the older students."
Meanwhile, among junior high students, drug use appeared to climb slightly, but the results were not "statistically
significant."
According to the new survey, 22.5% of high schoolers said they used at least one illicit drug on a monthly basis,
while 35.3% used a drug at least once in the 2000-01 school year. By contrast, in the 1999-2000 year, 21.3% reported
monthly use, and 34.3% reported yearly use.
The drug increase marked the survey's first discovered "reversal against progress" since the 1996-97 school year.
The results may steer federal policymakers to step up their drug prevention efforts with older teens.
The White House's Office of National Drug Control Policy says that it has primarily targeted students aged 11-13
in its anti-drug media campaigns. But Arthur Dean, chairman of Community Anti-Drug Coalitions of America, says, "We
need to expand upon these media and education programs and do a better job curbing drug use among high school
students."
Thomas Gleaton, founder of the Pride survey, also says the results point to the possible need for increased efforts
to target older teens in antidrug campaigns.
The Pride survey was conducted during the recently concluded school year and involved nearly 76,000 students in
grades 6 through 12. It is the largest independent measure of youth drug use.
The survey also found that students living only with their father were more likely to use drugs than those youth in
any other family configuration. By contrast, those students who lived with both of their parents were the least likely
to report any use of illicit drugs.
Meanwhile, the survey brought some good news. Student use of alcohol and cigarettes dropped to its lowest level
in more than 10 years, it said. Some 52.1% of students in grades 6 through 12 said that they had used alcohol
within the last year, which was the smallest percentage since 52.0% reported this pattern of use in 1987-88.
For cigarettes, the survey found that annual use was 30.5% among those in grades 6 through 12; in 1987-88, 29.1% of
students had reported smoking.
The survey also found the following: Compared with last year, slightly fewer kids said their parents talked with
them frequently about the risks of alcohol and drugs. Children whose parents never talked to them about illicit drugs were far
more likely to use these substances than kids whose parents spoke with them "a lot" about the problem. Students with
clear rules about family standards were much less likely to report use of illegal drugs. Children who often attended
religious services were less likely to report illicit drug use.
These results, says Edward Jurith, the White House acting drug czar, "confirm the importance of parental involvement
in children's lives as one of the key factors in keeping kids off drugs."
Jurith says, "Youth with strong parental influences and access to local support networks are much less likely to use
illegal drugs."
Carl Pickhardt, PhD, author of Keys to Raising a Drug-Free Child, tells WebMD, "what parents want to do is keep their
kid as anchored as possible in activities and relationships that they really care about."
More Kids Living With Grandparents By GENARO C. ARMAS, Associated Press Writer WASHINGTON (AP) - It's no longer
just a place to visit on weekends and holidays - for more American children, Grandma and Grandpa's house is home.
The number of kids under age 18 living in a grandparent-headed home increased in nearly every state for which the
latest round of 2000 census data is available. Figures released Wednesday for Florida, for instance, showed 258,952
kids living in such homes, a 33 percent rise since 1990.
The trend is reminiscent of the pre-World War II years, when three-generation households were not uncommon, said Gregory Brock, director
of the University of Kentucky Family Center.
But the findings also come at a point when the issue of visitation and custody rights for grandparents has become
a sensitive one in courts and legislatures across the country.
And for grandparents raising kids without one of the grandchild's parents living with them, it has become an unexpected
financial burden that lawmakers must ease with more financial assistance, said Amy Goyer, a program coordinator for
AARP. AARP is the country's largest advocacy group for senior citizens.
Jim and Toni Landenberger, of Naples, Fla., were awarded custody of their two grandsons after their daughter -
the boys' mother - was sent to prison and the boys' father died. A lengthy custody fight with the father's family drained
their savings.
The Landenbergers say they are happy and that the fight for their grandsons was worth it. But money concerns weigh
on their mind.
``It's nothing you really planned for, because there is no such thing as retirement now,'' Mrs. Landenberger said.
``You are doing things around school that you hadn't planned on doing.''
The figures offer another perspective into the more diverse makeup of the American family highlighted by the 2000
census.
In Florida, for instance, the percentage of children under 18 living in a grandparent-headed home rose from 6.8
percent in 1990 to 7.1 percent in 2000.
Children living in married-parent homes still represented the majority in Florida - 2.2 million, or 61.3 percent of
all kids there in 2000. But that share was down from 65.8 percent a decade ago.
Data also released Wednesday for Hawaii showed that 12.9 percent of children there lived in a grandparent's home
in 2000, up from 10.4 percent in 1990.
Meanwhile, 61.9 percent of Hawaiian kids lived in married-parent homes in 2000, down from 69.4 percent in 1990.
``Society in general is beginning to understand more about grandparents raising grandchildren,'' said Kathy Reynolds,
of Enfield, Conn. After her daughter went into drug rehab, Reynolds gained custody of her 5-year-old granddaughter.
A 1997 Census Bureau (news - web sites) survey estimated that more than half the kids living in grandparent-headed
homes had their mother living in the house with them. About one-third of the homes did not include one of the grandchild's
parents.
National numbers from the 2000 census will not be available until after all 50 states get their data, expected by
mid-August.
Additionally, these figures do not show, for instance, the number of grandparents living in a home headed by their
own son or daughter and play a caregiving role for grandchildren. That kind of information is expected to be released
next year.
The 1990 census found 3.5 million children under age 18 in the United States, or 5.5 percent of kids, living in
a grandparent-headed home, up from 3.2 percent of kids in 1970.
While previous studies have shown that grandparent-headed households occur more in low-income families, divorce,
career choices and job constraints are causing the numbers to rise in all socio-economic groups, Brock said.
An increase in drug abuse in recent decades has also contributed to the trend as addicted parents suffer health
problems, enter rehabilitation programs, or are jailed, he said.
Embalmed Cigarettes Gain Popularity By JOANN LOVIGLIO, Associated Press Writer PHILADELPHIA (AP) - Embalming
fluid is becoming an increasingly popular drug for users looking for a new and different high - one that often comes
with violent and psychotic side effects.
Users - mainly teen-agers and people in their 20s - are buying tobacco or marijuana cigarettes that have been soaked
in the fluid, then dried. They cost about $20 apiece and are called by nearly a dozen names nationwide, including
``wet,'' ``fry'' and ``illy.''
``The idea of embalming fluid appeals to people's morbid curiosity about death,'' said Dr. Julie Holland of New
York University School of Medicine. ``There's a certain gothic appeal to it.''
Formaldehyde can be bought in drug stores and beauty supply stores. (It is an ingredient in nail care products).
It is also available in many school science labs. In addition, there have been reports of embalming fluid thefts
from funeral homes in Louisiana and New York.
Although there are no national statistics on usage, many drug experts say it appears to have spread from the inner
cities to well-to-do suburban neighborhoods and college campuses.
``Whether they live in a million-dollar house or a $5,000 house, kids who are smoking pot or crack and are looking
for a different type of high are turning to wet,'' said Julie Kirlin, a juvenile probation officer in Reading,
about 50 miles from Philadelphia.
Embalming fluid is a compound of formaldehyde, methanol, ethanol and other solvents. The high depends on what the
user is really getting: Often the drug PCP is mixed in. In fact, PCP has gone by the street name ``embalming fluid''
since the 1970s.
Twenty Houston-area users interviewed for a 1998 study by the Texas Commission on Drug Abuse said the effects include
visual and auditory hallucinations, euphoria, a feeling of invincibility, increased pain tolerance, anger, forgetfulness
and paranoia. Stranger symptoms reported include an overwhelming desire to disrobe and a strong distaste for meat.
Other symptoms may include coma, seizures, kidney failure and stroke. The high lasts from six hours to three days.
``Fry users are described like those who do a lot of inhalants - they're just spaced-out, dissociative,'' said Jane
Maxwell of the National Institute on Drug Abuse's Community Epidemiology Work Group. When they've taken PCP, ``they
come into the emergency room and are just wild. They have to be strapped down in their beds or they destroy the room.''
In the Philadelphia suburb of Doylestown, a 14-year-old boy fatally stabbed a 33-year-old neighbor more than 70
times last year after smoking wet. The boy, who said he took wet to quiet the voices in his head, is serving a seven-year
sentence.
``This is a violent drug, and it will turn into a big fire if it's not watched very closely,'' Kirlin said. --
'Intense' Psychiatric Care May Not Cut Violence
Updated: Fri, Nov 09 1:51 PM EST
By Amy Norton
NEW YORK (Reuters Health) - "Intensifying" outpatient treatment for mentally ill patients at high risk for violence
does not appear to make a dent in their violent tendencies, UK researchers report.
Their study findings suggest that whole new strategies to tackle problems such as substance abuse and poor adherence
to medication are needed.
In the study, about 700 people with psychotic illness received outpatient care coordinated by case managers--health
professionals who meet with patients regularly and help organize the various aspects of an individual's care. Those
in the intensive-management group met with case managers twice as often as patients under standard care did, the report
indicates.
But after 2 years, the rates of violent acts were nearly identical in the two groups. Twenty-three percent of patients
in the intensive group and 22% in the standard group committed assault during the study period, according to findings
published in the November 10th issue of the British Medical Journal.
Younger patients, those who had been victimized themselves and those who abused drugs were among the patients most
likely to commit violent acts.
"What (this study) might suggest is that psychotic patients with a propensity for violence or with risk factors for
violence--for example, substance misuse--may require a specific range of interventions," the study's lead author, Dr.
Elizabeth Walsh of the Institute of Psychiatry in London, told Reuters Health.
Such interventions would include substance abuse treatment and efforts to make patients comply with their medication,
according to Walsh.
She noted that in the US, many states have "involuntary outpatient commitment," in which certain patients are legally
required to stick with their outpatient psychiatric care. One study, Walsh's team reports, has suggested that when coupled
with routine care, "enforced community treatment" reduces violent acts among patients at high risk for violence.
In an editorial published with the report, Dr. Tilman Steinert writes that "actually, a rather effective treatment
for violence in seriously mentally ill people is available, but only for limited periods: hospital treatment."
Factors in violence such as drug use, noncompliance with medication and "criminal peers" are minimized when patients
are in hospitals, notes Steinert, of the Centre of Psychiatry at the University of Ulm in Germany.
Walsh, too, said that for some mentally ill patients, hospitalization may be needed.
"On some occasions," she said, "it is necessary for patients to be detained for their own safety and the safety of
others." However, Walsh added, it is wrong to "lock people up and throw away the key" rather than search for other strategies
to help them.
Steinert agrees that other treatment options must be explored, writing that "further research should address the question
of whether forms of compulsory outpatient treatment combined with psychosocial support can be developed." SOURCE:
British Medical Journal 2001;323:1080-1081, 1093-1096.
Alcoholism: Clinical & Experimental Research How 'negative emotionality' can make you feel sick "Negative
emotionality" (NE) reflects a tendency toward depression, anxiety, and poor reaction to stress. Prior studies have shown
that adolescents with alcohol use disorders (AUDs) self report more health problems than 'normal' adolescents do. A
new study has found that adolescents with AUDs self report many more health problems than supported by laboratory and
physical exam findings. These reported health problems seem to be predominantly of psychological origin or NE.
"Negative emotionality" (NE) is the antithesis of positive thinking. NE refers to a propensity toward depression and
anxiety, and a tendency to react to stressful situations with unpleasant emotions. A study in the September issue of
Alcoholism: Clinical & Experimental Research examines the relevance of NE to health problems self reported by adolescents
with alcohol use disorders.
"Everyone has a degree of negative emotionality," said Duncan B. Clark, a psychiatrist, psychologist, director of
the Pittsburgh Adolescent Alcohol Research Center, and lead author of the study. "This is not a disorder or a categorical
trait; it is the degree to which an individual reports certain emotional characteristics."
Prior studies had shown that adolescents with alcohol use disorders (AUDs) tend to self report more health problems
than 'normal' adolescents do. Self-reported health problems may also be considered health complaints. Information about
the origin of these problems/complaints was less forthcoming, which prompted Clark and his colleagues to undertake their
study.
"There are four likely explanations," said Clark. "One, these symptoms may be due to biomedical problems caused by
alcohol. Two, they're related to cigarette smoking, also common in this group. Three, the complaints may be related
to anxiety and depression, and may therefore be considered 'psychosomatic.' Four, adolescents with alcohol use disorders
have relatively poor health maintenance and, therefore, more health problems as a result. We found evidence that all
four of these mechanisms are operating."
Study participants (the average age was 16 years) were asked to self report health symptoms from 136 possibilities
in 15 areas (such as sleep, heart and lungs, and neurology), have three serum liver enzyme levels measured, submit to
physical examinations by a medical professional, and have their NE measured via questionnaires and an interview. Certain
connections were immediately apparent among the group with AUDs. Symptoms linked to heart and lungs, such as shortness
of breath, were correlated with smoking. The liver enzyme elevation, albeit modest, demonstrated a risk for liver injury. Abnormal
oral exam results reflected poor health maintenance. However, said Clark, whereas laboratory and physical exam findings were
relatively normal, self reported health problems or health complaints were highly elevated.
"Most of the complaint areas were highly correlated with negative emotionality," he said, "our index of anxiety and
depression. The apparently small degree of organ disease or damage evident in the laboratory results and physical exams
suggests that the health problems were predominantly of psychological origin. However, I would not go so far as to say
these health problems were 'all in their head.' Anxiety and depression have been shown to cause demonstrable physical
changes."
Alcohol use and associated problems typically begin during the teenage years, and often rise dramatically. In 1999,
according to the 10th Special Report to the U.S. Congress on Alcohol and Health, 52 percent of 8th graders (14-year-olds)
and 80 percent of 12th graders (18-year-olds) reported having used alcohol at least once. Research indicates that rates
of AUDs also rise dramatically during adolescence, and are nearly as high as those of adults by the end of this period
(18 years of age).
"Adolescents' alcohol involvement is occurring during a period of time when their bodies are still developing," said
Sandra A. Brown, chief of psychology at the VA San Diego Healthcare System and professor of psychology and psychiatry
at the University of California, San Diego. "Early and protracted alcohol use by teens can have both short and long
term health effects. For example, in our studies of youth evaluated over a six-year period, we found that respiratory,
and accident and trauma injuries, were particularly more prevalent among youth with alcohol use disorders than among youth with
similar backgrounds but without alcohol use disorders. We've also found that health problems are more severe the longer
that heavy alcohol use goes on during adolescence, and that girls report more adverse effects than boys. Clearly," she
added, "alcohol use disorders during both adolescence and adulthood have important ramifications for an individual's
medical health, mental health, and cognitive functioning."
"What this study highlights," said Brown, "is that negative emotions and alcohol use disorders go hand in hand. What
remains to sort out is when those negative emotions are substance/alcohol induced, as they can be in adults, and when
they are a factor that could lead someone to use alcohol, and consequently, have the health problems that were examined
in the Clark study."
Co-authors of the Alcoholism: Clinical & Experimental Research paper included: Kevin G. Lynch and John E. Donovan
of the Pittsburgh Adolescent Alcohol Research Center; and Geoffrey D. Block of the Department of Surgery at the University
of Pittsburgh School of Medicine.
The study was funded by the National Institute on Alcohol Abuse and Alcoholism. Contact: Duncan B. Clark, M.D.,
Ph.D. clarkdb@msx.upmc.edu 412-624-2636 Pittsburgh Adolescent Alcohol Research Center Add'l Contact: Sandra A. Brown, Ph.D. sanbrown@ucsd.edu 858-822-1887 University of California, San Diego Report by Glaxosmithkline And Neuromed Scientists Points Way to New
Path in Addiction Research-Study in Nature Neuroscience Shows Mice Lacking Brain Receptor to Be Free of Cocaine Effects PR
Newswire - September 4, 2001
PHILADELPHIA, Sep 4, 2001 /PRNewswire via COMTEX/ -- Mice devoid of a single brain receptor, mGluR5, appear free
from the psychostimulant and the reinforcing effects of acute and repeated administration of cocaine, it is reported
in the September issue of Nature Neuroscience.
The findings point toward a novel understanding of the biological processes underlying drug dependence. It has been
known that following chronic administration of cocaine, the expression of mGluR5 (metabotropic glutamate receptor subtype
5) is increased in a region of the brain (the nucleus accumbens) within the brain's "natural reward circuit". The currently reported
study, in which the mice were rendered devoid of mGluR5 by genetic mutation, now provides compelling evidence of the functional
role of this receptor in the behavioural effects of cocaine.
The report is based on work by GlaxoSmithKline (NYSE: GSK) researchers at the Centre of Excellence for Drug Discovery,
Psychiatry, in Verona, Italy, and at the GSK Experimental Pathology Department at the Institute of Cellular Biology
and Morphology in the University of Lausanne, Switzerland. Also contributing were scientists at the Neuromed Institute
in Pozzilli, Italy, an institute for scientific and clinical research associated with the University of Rome La Sapienza.
"Although we have yet to elucidate the exact nature of the mGluR5 contribution to cocaine dependence, regardless of
the specific mechanism involved, these results suggest that mGluR5 is essential to that dependence," said Dr Francois
Conquet, an author of the paper and the leader of the research team in Lausanne.
Glutamate, the neurotransmitter that binds to the mGluR5 receptor, is the principal excitatory neurotransmitter in
the mammalian brain. It exerts various actions by means of multiple receptor proteins. Historically, however, the psychostimulant
and reinforcing effects characteristically induced by cocaine have been thought to be more closely associated with a different
neurotransmitter, dopamine. Cocaine is known to block dopamine re- uptake in nerve cells, increasing the level of extracellular
dopamine. It has long been suggested that this increase in dopamine levels is the primary cause of the behavioural effects
of cocaine.
Yet in the report in Nature Neuroscience, Dr. Conquet said, "We show that, although dopamine levels are still increased
by cocaine, the reinforcing and stimulant effects appear to be mediated by glutamate through mGluR5 while the specific
role of dopamine is not clear."
Functional examination of the different mGluR5 subtypes allowed researchers to compare responses of mGluR5-gene-mutated
mice and normal, or wild-type, littermates to experimenter-administered cocaine or in cocaine self-administration models
designed to investigate the reinforcing properties of cocaine.
The mutant mice displayed none of the characteristic stimulant effects of cocaine administration, such as hyperactivity.
"Locomotor activity was unaffected," said Dr. Conquet, "despite cocaine-induced increases in nucleus accumbens dopamine
levels similar to those in wild-type mice." In the cocaine self-administration model, which allows mice to press a lever
for a cocaine dose, the mutant mice didn't self-administer at any of the doses tested, though they did learn to press
a lever to receive food.
Moreover, in normal mice, administering a drug that temporarily blocked mGluR5 function led to decreased cocaine self-administration.
The team conducted additional studies showing that both brain distribution and expression of dopamine receptors and
dopamine transporter were not altered following mGluR5 mutation-further evidence that the responses to cocaine seen
in mutant mice were not due to any mGluR5-mutation-induced alterations in dopamine activity.
"This biological understanding offers our research centre a significant opportunity for further research intended
to discover new therapies for drug dependence," said Dr. Emiliangelo Ratti, Senior Vice President at the GSK centre
in Verona. "If these results can be expanded to other drugs of abuse, medicines acting on this target could be of benefit
in the clinical treatment of drug dependence, a disease with large unmet medical needs and widespread social impact."
Study: Drug Use Declining Among College Students By Charnicia E. Huggins NEW YORK (Reuters Health) - Gone are
the days when college students could say ``everybody's doing it''--with the ``it'' referring to drug use, new study
findings suggest.
Drug use during the college years seems to be declining, researchers report. And drug users are exhibiting distinctly
different lifestyle behaviors and values from those of their non-drug-using peers.
``It appears that drug use is becoming a little less 'mainstream' and a little more 'deviant' on the campus than it
was one or two decades ago,'' study lead author Dr. Harrison G. Pope, Jr., of Harvard Medical School in Massachusetts,
told Reuters Health.
Pope and his colleagues performed a 30-year study of various groups of senior undergraduate students at a college
in New England. The students completed questionnaires in 1969, 1978, 1989 and 1999.
Findings show that the students' use of cocaine, LSD, opium and other drugs peaked in 1978 and declined in subsequent
years, the investigators report in the September issue of the American Journal of Psychiatry. The one exception was
the increasing use of MDMA (Ecstasy) in later years, which subsequently made the drug one of the most frequently tried
illicit substances, second only to marijuana, the authors note.
Differences between drug users and non-drug users also became more apparent in later years, the report indicates.
Previously, such differences were limited to a greater number of psychiatrist visits and higher levels of heterosexual
activity among users than non-users, and both of these factors remained significant in 1999, findings show.
Nearly one quarter of college drug users reported having visited the psychiatrist, compared with 15% of students who
did not use drugs. More than three quarters of college drug users reported sexual activity, compared with less than
half (43%) of non-drug users, the report indicates.
However, 1999 data also revealed that college drug users had worse grades than their non-drug-using peers and that
they spent less time participating in extracurricular activities. College drug users were also more likely to report
homosexual activity than non-drug users.
Pope's findings conflict with national data, which shows that drug use during the college years may actually be increasing,
according to Susan Foster of the National Center on Addiction and Substance Abuse at Columbia University in New York.
Foster was not involved with Pope's research.
While it is a ``very interesting piece of research,'' she told Reuters Health, it is equivalent to a case study because
it involved students from only one institution. Because of this, ``(one) can't draw national conclusions,'' she said. SOURCE:
American Journal of Psychiatry 2001;158:1519-1521.
Marijuana Abuse May Up Risk of Depression By Suzanne Rostler NEW YORK (Reuters Health) - Adults who abuse marijuana
may be putting themselves at risk for depression, results of a new study indicate.
According to the report, adults who were not depressed when the study began but who abused marijuana were about four
times more likely to report symptoms of depression 15 years later, compared with their non-smoking peers.
These adults were especially likely to have had suicidal thoughts and report a lack of interest in things that once
held their interest, Dr. Gregory B. Bovasso reports in the December issue of the American Journal of Psychiatry. Pot
smokers were four times more likely than their non-smoking peers to have suicidal thoughts, and white women were found
to be at particular risk.
In the study, marijuana abuse was defined by various signs of problem pot use, such as impaired work performance or
using the drug on the job.
Individuals who used other drugs such as amphetamines and opioids were about 8 to 10 times more likely to be abusing
pot 15 years later. However, those who were depressed when the study began were no more likely to abuse marijuana later
on, according to the report, which followed nearly 850 adults who were not depressed and more than 1,800 who did not
report marijuana abuse at the study's start.
In an interview with Reuters Health, Bovasso suggested that future studies investigate how excessive pot-smoking leads
to a higher risk of depression, examine why adults abuse marijuana and establish how much pot is enough to put people
at risk of becoming depressed.
In the meantime, the findings ``underscore the importance of cannabis abuse prevention rather than treatment,'' because
they highlight new cases of depression arising among marijuana abusers, the report concludes.
``Treatments or other interventions that prevent the abuse of cannabis from occurring in the first place are important,''
Bovasso said. ``On a general policy level, marijuana...may not be as harmless as many believe.''
SOURCE: American Journal of Psychiatry 2001;158:2033-2037.
Some Drug Abusers Wait 10 Years to Seek Treatment
By Charnicia E. Huggins
NEW YORK (Reuters Health) - The vast majority of drug users and abusers are not receiving substance abuse treatment,
past research has shown. Now, study results show that many people with substance abuse problems do seek treatment at
some point in their lives, but they often wait 10 or more years to do so.
``Prevention is wonderful, but among the people who don't 'just say no,' we need more opportunities for early help
for those who have clinically significant problems,'' lead study author Dr. Ronald C. Kessler of Harvard Medical School
(news - web sites) in Boston, Massachusetts, told Reuters Health.
His study's findings are based on surveys of roughly 3,500 adults from Canada, Mexico and the United States who at
some point in their lives had symptoms that satisfied the criteria for substance abuse or dependence.
Overall, 1,230 survey respondents said that they were seeking treatment for their disorder, according to the report
in the November issue of Archives of General Psychiatry.
The average length of time that passed between the onset of their dependence symptoms and their seeking treatment,
however, was 10 years or more, with some individuals in the United States taking more than 16 years.
This long wait may be partly caused by embarrassment or other psychological barriers or by legal barriers--for example,
the idea that if you seek treatment, you are admitting that you're breaking the law, Kessler said.
On the other hand, ``whether this long lag time should be a source of concern is questionable since much of this time
might be spent with only one or two symptoms of abuse that do not warrant treatment,'' Kessler's team writes.
Individuals who reported using more drugs than they intended or using drugs for longer periods than they intended,
as well as those who had tried unsuccessfully to cut down on their drug use, were more likely to report seeking treatment,
the report indicates. People who had gone through withdrawal in the past were also more likely to seek treatment.
Also, survey respondents who reported using cocaine and heroin were more than twice as likely to seek treatment as
those who did not.
``One plausible interpretation of these results is that cocaine and heroin are more likely than other substances to
lead to impairments or symptoms that promote treatment seeking,'' the authors note.
In other findings, people whose substance abuse or dependence started when they were 30 or older were more likely
to seek treatment than those who had started using drugs earlier.
``The earlier substance disorder starts the less likely you are to get treatment,'' Kessler said. Drug use or abuse,
when begun at a young age, becomes a part of the user's life, but when begun later, it is more of a disruption of life,
he explained. ``The trick is early intervention.''
SOURCE: Archives of General Psychiatry 2001;58:1065-1071. Marijuana's Effects: More Than Munchies January 29, 2002 By
LINDA CARROLL - - NY Times Dawn was 12 when she started smoking marijuana with her friends. It was just something the
cool kids did to relax and forget their problems, she says.
But, after a while, the cigar-shaped "blunts" she smoked also seemed to make learning difficult. "I would just forget
school stuff," said Dawn, now 17. "I'd learn something one day and the next day I'd have no idea what the teacher was
talking about."
At first Dawn, a Long Islander, limited her marijuana smoking to the weekends, but soon it became an everyday habit
that ultimately landed her in a residential treatment program run by Phoenix House.
The debate over whether marijuana is harmful and habit-forming, as Dawn found, or a fairly benign intoxicant, is
an old one.
And until recently little research had been done to settle the controversy. For several decades, research on marijuana lagged
that for other illicit substances as scientists focused on the drugs like cocaine and heroin with more obvious addictive
qualities and more drastic and dire effects on users.
But in the past decade, and in particular over the last year or so, interest in cannabis has surged, driven in part by
the debate over medical marijuana use for pain relief, nausea and loss of appetite by people with AIDS, cancer and other
debilitating diseases. In addition, experts are intrigued by the discovery of molecules that naturally occur in the
body, known as endogenous cannabinoids, or endocannabinoids, which are remarkably similar to the active ingredient in
marijuana.
Researchers have discovered that receptors for the endocannabinoids are sprinkled liberally throughout the body
and the brain, suggesting that they play important roles in regulating a variety of processes.
Recent research into the ways that cannabinoids regulate appetite, pain and memory may not only shed light on the abundance
of sensations experienced by marijuana users - the mellow, the munchies and the fuzzy memory - but may help scientists
develop new, more directed medications to help control appetite, ease pain and improve memory.
Scientists have also learned that the drug, which an estimated 70 million Americans have at least tried, may be highly
addictive to a small percentage of those who use it.
Marijuana smokers report a diverse collection of sensations, and researchers now suspect that is because the drug's
main active ingredient - delta-9-trans-tetrahydrocannabinol, or THC - is so similar in shape to the endocannabinoids,
which are involved in many body and brain functions.
Dr. Rachel Wilson, a researcher at Caltech, discovered when she was at the University of California at San Francisco that
endocannabinoids played an important role in the hippocampus, a part of the brain involved in learning and memory, according
to a report published this spring in Nature.
No one has figured out exactly how endocannabinoids are used in the hippocampus, but based on the abundance of cannabinoid
receptors in this part of the brain and on the experiences of marijuana users, Dr. Wilson suspects that these molecules
help lay down new memories by strengthening the connections between nerve cells.
But when the brain is flooded with cannabinoids through marijuana use, forgetfulness results, Dr. Wilson said. It is
probably a case of too much of a good thing, she added. When cannabinoids are abundant, every experience becomes strongly
linked in our minds, she believes. But when everything is marked for memory, the system is overwhelmed and nothing is
remembered.
Dr. Wilson and others also reported last year on another important role played by cannabinoids. They appear to tone down
the production of certain neurotransmitters, acting like the brakes of a car when the system is racing too fast.
Another study published this last year in Nature may explain why marijuana users get a case of the munchies. An international
group of researchers found that mice that were genetically engineered to be deficient in cannabinoid receptors ate 40
percent less than normal mice. And in a separate experiment, the researchers showed that an interplay existed between
the cannabinoids and leptin, a hormone that produces satiety.
In the study, obese rats that were genetically modified to have low levels of leptin produced higher amounts of endocannabinoids.
When the rats were given leptin, the endocannabinoid levels dropped.
Yet another study on cannabinoids published last year may explain why marijuana makes people feel good. According
to the study published in Science, cannabinoids, through a complex chain of events, rev up the dopamine system.
Like other addictive substances, marijuana appears to hijack brain circuitry that evolved to help people find their
way back to a food source or sexual partner. Normally the neurotransmitters and receptors "are doing a long, slow dance,"
Dr. Wilson said. "Drugs of abuse crash the party and bring the booze."
Perhaps the most contentious issue has been the question of whether marijuana could be addictive. For the many Americans
whose experience with marijuana was pleasant and brief, it may be hard to believe that the drug can be strongly addictive.
But scientists focusing on cannabis have come up with a complicated picture. While a majority of people seem to be able
to quit, there appears to be a small segment of the population - some 10 to 14 percent - that can become strongly dependent
on the drug. And some addiction experts fear that this possibility will have serious consequences for the young, noting
that addiction among teenagers is on the rise in certain cities (New York and San Francisco among them). Marijuana use
in teenagers like Dawn can block social development and derail career plans, said Dr. Alan I. Leshner, former director
of the National Institute on Drug Abuse.
People often fail to notice that a friend or neighbor has a marijuana problem because the consequences of cannabis
use are less striking than those associated with other drugs, said Dr. Alan J. Budney, associate professor at the University
of Vermont and director of its Treatment Research Center.
"You don't see the severe acute consequences you get with alcohol or cocaine," Dr. Budney said. "People don't embarrass
themselves. They don't wreck the car. They don't spend all their money on a binge.
"That doesn't mean it's not addictive. It can be insidious. It gets into your lifestyle and then you can't get it
out."
For years, even addiction experts have argued over the effect of cannabis.
"There is still some debate regarding the degree, or extent, or magnitude of dependence and what the real consequences
of that dependence might be," said Dr. Billy R. Martin, a professor and chairman of pharmacology at Virginia Commonwealth
University in Richmond.
One sticking point was the absence of an animal model. But slightly over a year ago scientists at the National Institute
on Drug Abuse showed that monkeys give themselves THC in amounts comparable to that inhaled by people who smoke marijuana,
according to a study published in Nature Neuroscience. Such self-administration of drugs by animals has been shown to
be a hallmark of addictive substances.
And more recently, reports have described a withdrawal syndrome that can last several weeks, another sign of addiction.
In a study that followed heavy marijuana users, Dr. Budney found that when people quit using the drug, they experienced
a host of unpleasant symptoms, including craving, decreased appetite, sleep difficulty, weight loss, aggression, anger,
irritability, restlessness and strange dreams.
Often these symptoms drove people back to using the drug, said Dr. Budney, who noted that the marijuana withdrawal syndrome
was very similar to what cigarette smokers experienced when they quit.
Still, compared with alcohol, the physical side of marijuana withdrawal is mild, experts say.
Nevertheless, for those with a predisposition to be hooked by cannabis, the pull of the drug is intense.
For Mark, a restaurant owner from Vermont, the craving for cannabis was too strong to ignore. Mark, 40, started smoking
it when he was 13 and was smoking daily by the time he hit college. "When I woke up I genuinely didn't feel well until
I smoked," he said.
Although he tried many times to quit over the years, he did not succeed until he attended a treatment program.
Still, not everyone is convinced that marijuana is a threat.
"Everything is relative," said Dr. Donald Jasinksi, a professor of medicine at the Johns Hopkins medical school and
director of the Center for Chemical Dependence at Johns Hopkins Bayview Medical Center. "Does it destroy as many lives
as alcohol? No. Does it kill as many people as cigarettes? No. Does it have as many deaths associated with it as aspirin
overdose? No."
Mark, however, wistfully wonders what his life might have been like without marijuana. "I'm the only one in my family who
wasn't an Ivy Leaguer," he said. "I went to a crummy college. I should have been right up there with the rest of them."
-- In a PsychINFO search last evening I found another cite from Dr. Miller, as follows:
The Community Reinforcement Approach to the Treatment of Substance Use Disorders IN American Journal on Addictions,
2001, Vol 10, (Supplement), 51 -59. "In 3 recent metaanalyses, Community Reinforcement Approach was ranked as one of
the most efficacious and cost-effective alcohol intervention treatments available. ... resulted in significantly better overall
results than did traditional treatments. ... A CRA variant, Community Reinforcement and Family Training (CRAFT) targets
individuals refusing to seek treatment, by working through significant others. ... Empirical evidence strongly supports
CRA and CRAFT use in substance abuse disorder treatment."
So ... there is a developing base of evidence supporting involvement of family preservation techniques in both the
adult (CRAFT) and adolescent (MST) populationns.
Study Shows That Youth Need More Drug Programs USA TODAY - February 08, 2002 Nine out of 10 kids who need drug treatment
are not getting it, a comprehensive federal study of the nation's drug use has found.
The yearlong National Household Survey on Drug Abuse, conducted during the Clinton administration but issued this
week by the Substance Abuse and Mental Health Services Administration (SAMHSA), indicates that 1.1 million children
12-17 years old have problems with drugs and alcohol. Only about 122,000 of them got treatment in 2000, the study reports.
''Those kids are only the tip of the (drug abuse) iceberg,'' says Mitchell Rosenthal, head of Phoenix House Foundation,
the nation's largest non-profit drug-treatment program. The new study confirms Rosenthal's analysis. It shows that about
4.7 million Americans ages 12 and older are abusing or dependent on illegal drugs. Of that number, 3.9 million received
no treatment in 2000.
The figures also indicate that the need for treatment has grown over the past decade.
Previous government studies from 1991 to 1998 estimated that 2.5 million to 3.6 million people needed treatment but
did not get it.
Charles Curie, administrator of the Substance Abuse and Mental Health Services in Rockville, Md., says early intervention
is important.
''We need to target that (young) population. When we intervene earlier, the treatment results can be very effective,''
Curie says. ''If we can address the addictive disease, we can give these children the opportunity to get a life and
get a quality life,'' he says.
Bush administration officials say they will focus their efforts on an estimated 129,000 drug abusers of all ages.
That's the portion of the drug-abusing population that reported in the study that it sought treatment but was unable
to get it for a variety of reasons.
President Bush asked Congress this week to authorize a $127 million increase for drug treatment.
Drug experts say the money is a small step. Treatment for children is costly and scarce. Yearlong residential treatment
programs can cost as much as sending a child to a year of college, and drug programs are almost always at capacity.
Parents often must send their children away for treatment because programs aren't available locally.
Boys who need long-term residential treatment have a month-long wait for admission to the Caron Foundation drug-treatment
facility in Wernersville, Pa., says David Rosenker, vice president of adolescent services there. Most of them need six
months to a year of an intensive program, he says.
Treatment costs vary widely by the type of facility, the psychological needs of the patient, and the number and types
of drugs the person abuses.
''Families that have a lot of money can find access to just about anything,'' Rosenker says. ''Then there's everybody
else.''
To close the treatment gap, the government, health care providers and insurance companies must address funding, insurance
coverage, capacity and the stigma associated with seeking help for drug addictions, Rosenthal says.
He says the federal government should fund a public campaign to convince people that treatment works. Changing attitudes
toward drug treatment will encourage more people to seek help and convince taxpayers that spending public funds for
long-term treatment pays off, he says.
Teens: Stats Counter Stereotypes
The Topeka Capital-Journal - February 20, 2002 National Youth Risk Behavior Survey, an instrument of the Centers for
Disease Control and Prevention. The rate of teen-age pregnancy is declining, as is the proportion of teenagers who have
had sex. Cigarette smoking, drinking and the use of most illegal drugs are down. The suicide rate, although higher than
in other Western countries, has held steady for several years.
More students are graduating from high school now than 10 years ago. School test scores are the same as 30 years ago,
with minority students scoring slightly better than minorities in the past. Religious participation is stable, and the
number of young people performing community service has risen slightly, even in parts of the country where service is not
required.
"No one is going to deny the difficulties that teenagers face," Youniss says, "but you can't sustain the argument
that there's something really odd about these kids."
Yet the stereotypes endure, for several reasons, the image changers say. Age segregation is one. Psychologist Peter
Scales, senior fellow for the Search Institute, a Minneapolis think tank on youth issues, notes that fewer U.S. households
contain children or adolescents now than 40 years ago. teenagers don't have the contact with older adults they once had,
and humans tend to fear that with which they're not familiar.
Scientists who study youths and agencies who serve them frequently must demonstrate major deficits in teenagers to
acquire resources from government agencies and private foundations. If such specialists aren't careful, they can easily
conclude that many young people are troubled, and pass on those conclusions to an uninformed public.
In "Yes, Your Teen Is Crazy!" (Harbor Press), Philadelphia psychologist Michael Bradley makes such claims more than
the authors of the two other new books. To make his case that teenagers are temporarily insane, Bradley draws on the
work of Jay Giedd, a psychiatrist at the National Institute of Mental Health.
Giedd and other researchers used magnetic resonance technology to show that the part of the adolescent brain that
regulates emotions, impulses and decision-making grows rapidly until age 20. Bradley says this means that until they
reach adulthood, teenagers are "brain- challenged."
As indicated in his book's title, "How to Keep Your Teenager Out of Trouble and What to Do If You Can't" (Workman),
Washington psychologist Neil Bernstein focuses most of his attention on problems that can make parents feel they're
nearing the end of their rope: "I have dealt with family issues ranging from daily annoyances (sarcasm, dirty rooms, procrastinating
over homework) to significant crises (antisocial behavior, substance abuse, flagrant defiance. ...) Regrettably my business
is booming."
The book with the scariest title, "Parenting Your Out-of-Control Teenager" (St. Martin's) is the least frightening:
Social worker Scott Sells makes it clear he's describing only those young people who repeatedly demonstrate extreme
behaviors.
Work by the Search Institute suggests otherwise. Six years ago, the institute began helping communities identify and
increase the opportunities for local youths to learn and serve. To date, 560 communities, 24 states and two Canadian
provinces have signed on to the Search effort.
Starting from old assumptions may not get people to believe anything but the old assumptions, argues Ross Thompson,
psychology professor at the University of Nebraska: "As we shift through all the evidence relating to a particular subject,
we tend to remember that which confirms our earlier impressions and discount or forget that which is different."
Monitoring the Future Survey Reveals Some Positive Trends for Youth Substance Use from Brown University Child and
Adolescent Behavioral Letter The most comprehensive survey for measuring youth drug use in America has found that use
of most illicit drugs remains stable, while use of cigarettes continues to decline. The annual Monitoring the Future (MTF)
survey was released recently by the U.S. Department of Health and Human Services (HHS). The survey found decreases in cigarette
and heroin use, and most other substance use remained stable. The survey also found that the use of ecstasy (MDMA) was increasing
at a slower rate, while inhalant use has gradually declined, with a significant drop among 12th graders. However, there
also were some troubling findings concerning the perceived risk of smoking marijuana -- down more than 2 percent -- and disapproval
ratings of heroin and steroids. Use of steroids increased by almost 1 percent and at the same time, disapproval of steroid
use decreased among seniors. Since 1975, the MTF has annually studied the extent of drug use among high school students.
The 2001 study surveyed about 44,000 students in 424 schools across the country in three grades: 8th, 10th and 12th. The goal
is to collect data on past month, past year and lifetime drug use among students in these grade levels. The survey is conducted
by the University of Michigan's Institute for Social Research and is funded by the National Institute on Drug Abuse (NIDA).
Highlights of the Survey The reductions in teenage smoking come on the heels of increases from the early to mid-1990s
and are excellent news in the nation's battle to reduce the toll exacted by this leading cause of preventable death and disease.
"The finding that fewer teenagers are smoking is very encouraging as more teens are making smart choices that will help
them avoid tobacco-related health threats," said HHS Secretary Tommy G. Thompson. "Overall, drug use among America's teenagers
has remained level or declined for the fifth year in a row, and that's good news. But we must remain vigilant to the threats
that heroin, ecstasy, marijuana, alcohol and other dangerous drugs pose to our youth." Use of most other illicit drugs
remained stable from 2000 to 2001. Illicit drug use rates are below their peaks in 1986 for 8th graders; for 10th and 12th
graders, they remain largely unchanged from recent peak levels seen in 1997. Long-term trends available for 12th graders indicate
current levels of illicit drug use are well below their 27-year peaks from the late 1970s and early 1980s. John P. Walters,
director of the White House Office of National Drug Control Policy (ONDCP), praised the end of the explosive drug use increases
of the mid-1990s, but also said that use levels are still too high. While noting the decline in cigarette smoking, Walters
said, "It is time to make the anti-drug effort catch up with the anti-tobacco effort." "It is simply astounding that students
today are almost as likely to light up a joint or use another illegal drug as they are to smoke a cigarette," said Walters,
pointing to the finding that roughly similar percentages of students smoke cigarettes and use drugs. Acting NIDA director
Glen R. Hanson, Ph.D., said that he was pleased that the increasing use of ecstasy appeared to have slowed in 2001. While
increases were observed in all three grades, they were generally not as steep as in the past two years and were not statistically
significant. In addition, the perceived risk of harm from trying MDMA once or twice increased among seniors. Increases in
perceived risk are often harbingers of future reduction in rates of use. Marijuana Lifetime, past-year and past-month
use of marijuana remained statistically unchanged from 2000 to 2001. In 2001, past-year rates of marijuana use were 15.4 percent
for 8th graders; 32.7 percent for 10th graders; and 37 percent for 12th graders. In the 27 years that Monitoring the Future
researchers have been collecting data, past-year use among 12th graders peaked at 50.8 percent in 1979; the lowest rate was
21.9 percent in 1992. Since then, the rate reached a relative maximum of 38.5 percent in 1997. Perceived harm from regularly
smoking marijuana decreased from 74.8 percent to 72.2 percent among 8th graders between 2000 and 2001. Cocaine Cocaine
use, including both powder and crack, decreased slightly among 10th graders between 2000 and 2001. Lifetime use of cocaine
in any form decreased from 6.9 percent to 5.7 percent in this group, while lifetime crack use decreased from 3.7 percent to
3.1 percent, and past-year use of powder cocaine declined from 3.8 percent to 3 percent. Heroin Heroin use declined
among 10th and 12th graders. For 10th graders, past-year use decreased from 1.4 percent to 0.9 percent, and for 12th graders
it was down from 1.5 percent to 0.9 percent. Lifetime use also declined in both grades. Disapproval of using heroin once
or twice without a needle declined among 12th graders from 94 percent to 91.7 percent. Inhalants Inhalant use continued
a gradual decline, though the differences this past year were only statistically significant for 12th graders. For 12th graders,
past-year use declined from 5.9 percent to 4.5 percent; 9.1 percent of 8th graders and 6.6 percent of 10th graders reported
using inhalants in the past year. Perceived harm of using inhalants increased among 8th and 10th graders. Perceptions
of "great risk" from trying inhalants once or twice increased from 41.2 percent to 45.6 percent among 8th graders and from
46.6 percent to 49.9 percent among 10th graders. Steroids Seniors' use of steroids in the lifetime, past year, and
past month increased from 2000 to 2001. Past-year use among 12th graders increased from 1.7 percent to 2.4 percent. The disapproval
rate decreased among this age group. Tobacco Cigarette use by 8th and 10th graders declined in several categories.
Lifetime use decreased from 40.5 percent to 36.6 percent among 8th graders and from 55.1 percent to 52.8 percent among 10th
graders. Daily use decreased from 7.4 percent to 5.5 percent among 8th graders and from 14 percent to 12.2 percent among 10th
graders. The use of bidis also decreased among 8th and 10th graders. Past year use of these small, flavored cigarettes
went from 3.9 percent to 2.7 percent among 8th graders and from 6 percent to 4.9 percent among 10th graders. Rates of
smokeless tobacco use remained unchanged. In 2001, 4 percent of 8th graders, 6.9 percent of 10th graders and 7.8 percent of
12th graders reported using smokeless tobacco in the past month. Alcohol Between 2000 and 2001, alcohol use remained
mostly stable. Having been drunk in the past year declined among 8th graders, from 18.5 percent in 2000 to 16.6 percent in
2001. In an exception to the overall pattern, daily alcohol use increased among 12th graders from 2.9 percent to 3.6 percent.
The Monitoring the Future findings are available at www.drugabuse.gov/DrugPages/MTF.html. Brown University Child and Adolescent Behavioral Letter 18(2):1,6, 2002. © 2002 Manisses Communications Group, Inc
Monkey Cocaine Study Sheds Light on Drug Addiction By Will Dunham WASHINGTON (Reuters) - Social standing -- being
dominant or subordinate -- plays a vital role in determining susceptibility to drug use, scientists said on Tuesday
in a study using monkeys that may shed light on human addictions.
Researchers at Wake Forest University in Winston-Salem, North Carolina, found that macaque monkeys deemed to be subordinate
in small groups of the animals were much more likely to give themselves doses of cocaine in a laboratory setting than
dominant monkeys.
Brain chemistry linked to social rank explains the phenomenon, the scientists said in a study published in the journal
Nature Neuroscience.
Where an individual monkey stands on the simian totem pole is reflected in a brain chemical called dopamine, which
is intimately linked with cocaine and other types of substance abuse, they found.
The dominant monkeys experienced an increase in a type of dopamine receptor known to be involved in brain pathways
for reward processing, and were less vulnerable to cocaine abuse than their wallflower laboratory companions.
Michael Nader, who led the study, said the research demonstrated that environmental changes can have a profound impact
on brain chemistry relating to sensitivity to a given addictive drug -- a finding that could have parallels in people.
For example, researchers have pondered why some cocaine users end up as addicts while others do not.
Cocaine acts on the brain by raising levels of dopamine in synapses -- gaps between nerve cells -- with elevated dopamine
levels corresponding to the ``high'' experienced by the user. Dopamine, categorized as a ``neurotransmitter,'' is released
during normal nerve impulse transmission in the brain.
Nader and his colleagues studied 20 male monkeys. The animals initially were housed by themselves for a year and a
half. The researchers looked at the monkeys' hormonal activity and behavior, then used a sophisticated imaging technique
to measure chemical activity in the brain.
NEW ROOMMATES
A change in living arrangements was then imposed. The monkeys were moved into groups of four. In the ensuing social
interaction over three months, dominant monkeys emerged in the five groups, and a hierarchy was established.
The researchers then introduced cocaine to the monkeys, allowing them to self-administer doses. The five top monkeys
were far less likely to do so than the others.
Brain scans revealed that the dominant monkeys -- those that were the most aggressive and least submissive toward
others -- experienced major changes relating to dopamine starting after the group-housing arrangement was imposed.
Because these changes occurred after only three months of group housing and were not seen when the monkeys lived by
themselves, the scientists said the changes in brain chemistry resulted from the process of becoming dominant.
``The environmental consequences of those social hierarchies resulted in these changes,'' Nader said in an interview.
``And the changes were in the dominant animals and not in the subordinate animals. So the positive spin on that is
that environmental enrichment can produce rapid changes in the brain that, in this particular case, protected the individual
from drug abuse. And that is the applicability (to people).''
Nader said the findings involving these monkeys should not be interpreted to mean that, in people, those at the top
of the social ladder are the least susceptible to substance abuse.
``Not so much that every time you get a promotion or you move up in rank, you're less likely to abuse drugs. I don't
think it's the social subordination versus the CEO that's the main point. It's that environmental enrichment ... can
produce rapid and robust changes in the brain.''
Nader also said he envisions the development of drugs that mimic the brain chemistry changes that appear to reduce
cocaine susceptibility. But he added that many factors come into play in determining whether a person becomes an addict.
``There are other things going on, for sure,'' Nader said. ''So I shouldn't say that this is the end-all answer to
everything. But I think it is a very promising finding.''
Drugs and Shrinks Best Combo for Treating Heroin Addicts Swedish researchers used buprenorfin, which reduces addict's
heroin craving
SUNDAY, June 2 (HealthScoutNews) -- The majority of heroin addicts can be treated using a combination of drugs and
psychological therapy, says a new Swedish study.
The study included 40 heroin addicts who took part in group therapy once a week, had a weekly meeting with a contact
officer and were drug tested three times a week. Half the addicts were randomly selected to take a daily dose of 16
mg. of the drug buprenorfin, while the other half received a placebo.
After one year, 75 percent of the buprenorfin-treated addicts were still in treatment, compared to none of the control
group. Among the buprenorfin-treated addicts who remained, drug abuse dropped dramatically or ceased and their social
function improved, the researchers say.
They say buprenorfin does two things: It activates opiate receptors in the brain, but only to a limited extent compared
to heroin and methadone; and it reduces or eliminates the craving for heroin. If a heroin addict taking buprenorfin
relapses, the opiate receptors will be blocked, and the addict won't get the expected high from heroin.
The study was presented at a recent scientific conference in Oslo, Norway. --
Description: Homeless teen who identify as sexual minorities experience more physical and sexual violence, use
more drugs, have more sexual partners and have higher rates of mental illness than homeless straight youth, according
to a new study. (Am. J. of Public Health, May-2002)
Homeless youths who are gay, lesbian, bisexual and transgender have a perilous existence on the street. Compared to
heterosexual homeless youth, they experience more physical and sexual violence, use more drugs and abuse them more frequently,
have more sexual partners and have higher rates of mental illness, according to a new University of Washington study.
The study appears in the May issue of the American Journal of Public Health. The National Institute on Alcohol Abuse
and Alcoholism funded the research.
"A lot of people believe homeless adolescents are on the street by their own choice. That usually isn't the case,"
said Bryan Cochran, lead author of the study and a UW doctoral student in psychology.
"Their lives are something of a revolving door. These youth grow up in horrendous family environments. At home there
can be frequent physical and sexual abuse, and their parents often abuse alcohol and drugs. Life on the streets presents
them with new challenges. But neither place is very hospitable."
The subjects in the study -- 84 sexual minorities and 84 straight youth, all homeless -- were recruited as part of
a larger Seattle Homeless Adolescent Research and Education Project. Subjects were 13 to 21 years old when interviewed.
The researchers found that sexual minorities reported being physically or sexually victimized on average by seven
more people than did heterosexual homeless youth. Boys were more likely to have been abused in the past three months,
but girls reported more incidents of abuse while they were homeless. Sexual minorities reported leaving home an average
of 12 times compared to seven times for straight homeless youth.
The study showed sexual minorities had nearly twice as many sexual partners in their lives than did heterosexual homeless
youth, 24 vs. 13. Both groups reported having unprotected sex about half the time. However, Cochran said, the important
factor is who street youth are having sex with and sexual minorities may be more likely to be having sex with partners
who have HIV or other sexually transmitted diseases.
Many street youth are frequent drug users, but sexual minorities reported using 11 of 12 substances more frequently
during the previous six months. Marijuana was the only substance that heterosexuals used more frequently, but it was
the most widely used by both groups.
When it comes to mental health issues, Cochran said the "profile differences are striking" for homeless sexual minority
youth. They are uniformly at greater risk than other homeless adolescents for psychological conditions that may require
treatment, such as anxiety, stress, depression and delinquency. In addition, Cochran said their heavy substance abuse
will exacerbate future psychological problems and they have a more difficult time dealing with their sexual identity
than do heterosexual homeless youth.
"People tend to think homeless are an homogenous group. We are trying to show this isn't true," said co-author Ana
Marie Cauce, a UW psychology professor. "There are different characteristics and pathways onto the street and what happens
to groups when they are on the street. It is striking how vulnerable this group (sexual minorities) is.
"Street kids are not cute and cuddly. However, we sometimes lose sight of what a tough time adolescence can be. In
the past we used to have the Army or the ability to "go west" for youth who were having a hard time making it in more
traditional settings. But we don't have these any more and I worry about these kids in the long term," she said.
Cochran and Cauce said sexual minority street youth require intensified services, and that agencies and groups need
to be aware of potential prejudice because this population has been exposed to so much rejection based on their sexual
identity.
The study was multi-ethnic, with 53 percent of the subjects identifying themselves as white, 19 percent as American
Indian or Alaskan native, 18 percent as black, 7 percent as Hispanic and 3 percent as Asian or Pacific Islander. Fifty-five
percent were male. The overwhelming majority, 71 of 84, identified themselves as bisexual. Four females and eight males
identified themselves as lesbian or gay, respectively, and one youth identified as transgender.
Nationally, the estimated number of homeless street youth ranges from 600,000 to 1.5 million. The number of sexual
minorities among this population is unknown, although several studies estimate it at between 6 percent and 35 percent.
Other members of the research team were Angela Stewart, a UW doctoral student in psychology, and Joshua Ginzler, a
research coordinator with the UW's Alcohol and Drug Abuse Institute.
Study: evidence-based programs likely to be more successful in preventing substance use by children (Embargoed)
CHAPEL HILL - Scientifically designed substance abuse prevention programs based on research showing what works and what doesn't
are likely to be much more effective in keeping children off tobacco, alcohol and drugs than other programs not based on
such evidence, a new study suggests.
In part, that's because teachers using such programs tend to have been recently trained in teaching them and work
at schools where staffers have a positive attitude about making a difference, researchers say.
The national study, conducted at the University of North Carolina at Chapel Hill and the Pacific Institute for Research
and Evaluation (PIRE), involved analyzing how teachers and schools discourage substance use among middle-school students.
Investigators developed research-based standards for both content and delivery practices because earlier studies showed
both elements were central to the effectiveness of prevention programs, said Dr. Susan T. Ennett, associate professor
of health behavior and health education at the UNC School of Public Health. They then sent detailed questionnaires to
a random sample of 1,905 middle school teachers to find out which programs they used in the classroom and how they implemented
them.
"We found that about a quarter of the teachers were employing evidence-based programs as opposed to off-the-shelf
curricula that had not necessarily been evaluated or proven effective," Ennett said. "We also found that fewer than
a third of the teachers met the standards we created. Although that percentage was low, it was two-thirds higher than
for those teachers not using an evidence-based curriculum, and that's good news."
The UNC researchers were scheduled to present the findings in Seattle Saturday (June 1) at the annual meeting of the
Society for Prevention Research. Principal investigator for the study was Dr. Christopher Ringwalt of PIRE in Chapel
Hill.
"Both school and teacher characteristics were significantly associated with meeting our standards," Ennett said. "Most
notably, providers who were recently trained, reported comfort in using interactive delivery methods and were in a school
with a positive climate were more likely to implement curricula in accordance with these standards."
Her group's results suggest that teachers and schools need resources and support if evidence-based programs are to
be adopted and used as intended to achieve maximum results, she said.
Examples of evidence-based curricula include Project ALERT and Life-Skills Training. An example of a well-known substance
abuse prevention program not based on evidence is DARE, which recent studies have found to have little or no effect
in safeguarding children.
Programs found to be effective in steering them away from unhealthy substances emphasized social influences knowledge
and refusal skills and employed interactive teaching strategies such as role-playing. Such programs also taught them
about social skills, including decision-making and assertiveness.
Others involved in the research were Dr. Judy Thorne of Westat in Rockville, Md., Dr. Luanne Rohrbach of the University
of Southern California and Amy Vincus, Ashley Simons-Rudolph and Shelton Jones of RTI International.
The National Institute on Drug Abuse supported the new study, which will appear in an upcoming issue of the journal
Prevention Science.
Contact: Blair Gately
Neuronal differences in certain brain regions observed in chronic users of cocaine
Neuronal differences in brain regions involved in decision-making and other functions observed for the first time
in chronic users of cocaine \
Researchers at the University of Pennsylvania have detected differences in areas of the brain in chronic cocaine
users. These differences were detected in regions involved in decision making, behavioral inhibition, and emotional reaction
to the environment.
Using magnetic resonance imaging (MRI) and other brain mapping techniques, the researchers, led by Dr. Teresa R. Franklin,
examined 13 men who had used cocaine for an average of 13 years each. They found that, compared to controls who had
never used cocaine, select regions of the brains of the cocaine users had less gray matter. This decrease in critical working
brain tissue ranged from 5 to 11 percent. This is the first time in either animal or human studies that differences
in gray matter concentrations have been found in chronic cocaine users.
The investigators suggest that some of the behaviors observed in chronic cocaine use- such as choosing immediate gratification
over long-term reward; engaging in risky behaviors, particularly when attempting to obtain cocaine; and succumbing to
the overwhelming desire to seek and use drugs undeterred by the prospect of future negative consequences- may be a result
of these gray matter deficiencies.
WHAT IT MEANS: Understanding the long-term impact that cocaine can have on the brain and cognition will help scientists
to develop strategies to reverse those effects and, and, ultimately, restore the brain to normal function.
The study was published in the January, 2002 issue of Biological Psychiatry. It was funded by the National Institute
on Drug Abuse (NIDA).
Contact: Blair Gately
Long-term cognitive impairment found in crack-cocaine abusers
Impaired memory and motor skills were found in crack-cocaine users up to 6 months after their last use of the drug.
Individuals with a history of heavy crack use had the most severe impairments. The researchers believe that these deficits
are evidence of brain damage caused by substance abuse.
The NIDA-supported researchers administered a battery of comprehensive neuropsychological tests to 20 crack-dependent
subjects, 37 crack-and-alcohol-dependent subjects, and 29 individuals with no history of drug or alcohol abuse. The
tests were given twice-the first time following 6 weeks of abstinence from drugs and again after 6 months of drug abstinence. The
tests assessed the subjects' attention span, decision-making, spatial processing, immediate and delayed memory, calculation
ability, reaction time, verbal fluency, and psychomotor skills.
Both drug-abusing groups showed significant cognitive impairments at both the 6-week and the 6-month time points.
The largest effects were found in the executive function and spatial processing assessments.
WHAT IT MEANS: With approximately 2 million cocaine abusers in the United States, the finding that brain damage resulting
in long-term impaired mental and physical functioning can result from its use makes developing and utilizing effective
prevention and treatment methods an urgent public health priority.
The study was published in the February 2002 issue of Drug and Alcohol Dependence by a research team from Neurobehavioral
Research, Inc., Corte Madera, CA; University of Illinois at Chicago; and the Herrick/Alta Bates Hospital, Berkeley,
CA. Dr. George Fein was the lead author.
Meth Use on Rise Among U.S. Women Mon Jun 10, 1:49 AM ET By MIRANDA LEITSINGER, Associated Press Writer
DES MOINES, Iowa (AP) - To outsiders, Debra Breuklander appeared to be a tireless single mother of three. She had
an immaculate home in a middle-class suburb, perfect credit and was a homeroom mom at her children's schools.
She also was taking methamphetamine and selling the drug to make ends meet.
"I thought I was 'Super Mom' and I was doing everything right," said Breuklander, 43, now serving a 35-year prison
sentence. "In actuality, my thinking was so twisted. I was doing everything wrong."
Breuklander is among a growing number of women who have abused meth, a highly addictive stimulant that produces a
euphoria similar to cocaine, but lasts longer and is made from common household ingredients.
Experts and users say meth appeals to women because it's relatively inexpensive and easy to obtain, and it gives them
energy to take care of their children or feel more efficient in everything they do.
"There's no comparable drug that we've ever seen as long as I've been in substance abuse that appeals to women as
much as meth does," said B.J. VanRoosendaal, spokeswoman for the Utah State Division of Substance Abuse.
Nationally, women made up 47 percent of patients in substance abuse treatment centers who identified meth as their
primary drug of use in 1999, according to data from the U.S. Department of Health and Human Services.
In Iowa, 43 percent of women entering prison in the first quarter of fiscal 2002 said meth was their drug of choice,
compared with 29 percent of men. In fiscal 2000, it was 25 percent of women and 19 percent of men.
More than 40 percent of women arrested in the counties surrounding Honolulu and San Jose, Calif., in 2000 tested positive
for meth use, a National Institute of Justice program found, and the figure was more than 20 percent in several other
areas studied.
Miranda Charbonneau, like Breuklander an inmate at Iowa Correctional Institution in Mitchellville, said she turned
to meth after previously using marijuana. It soon became an obsession for the then 16-year-old who had left school and
was working.
Every day, the focus was, "where I could get it, who I could get it from, how much was it going to cost me ... and
what was I going to have to give up to get it," said Charbonneau, 23, who is serving 10 years for child endangerment.
"I gave up personal items with sentimental value. I sold a lot of my belongings ... I lost my car, I almost lost my
job. I ended up losing part of my relationships with my family," she said. "I began to steal to find ways of getting
methamphetamine."
Breuklander, a former nurse who was on disability for a degenerative back disease, said her relationship with meth
began with financial troubles. Her boyfriend at the time was selling meth and she joined in, selling it to a group of
friends.
"It all looked glamorous and wonderful and there was such a demand for it," she said.
"I think for a lot of women, especially single mothers, it gives you the energy that you think you need to keep the
house, the kids, the yard, the cars, the groceries, the laundry, everything going," she said. "At least, that's how
it took me over."
Sheigla Murphy, director of the Center for Substance Abuse Studies at The Institute for Scientific Analysis in San
Francisco, said she started seeing women fitting Breuklander's profile in the early 1990s.
"There seemed to be a little proliferation when people started to realize that cocaine was trouble and that's when
we started seeing more middle-class women drinking 'biker coffee,'" Murphy said. That drink is made by adding meth to
coffee.
"A lot of women use it for performance things or weight control," Murphy said.
Women "get into this for a lot of what many could consider to be good reasons," she said.
Women's meth use may initially be more concealed than that of men because of different reactions when they take it,
said Arthur Schut, president and chief executive officer of the Mid-Eastern Council on Chemical Abuse based in Iowa City.
Men abusing meth get police attention because they are more likely to be involved in assaults or to drive drunk. Women
are less likely to do those things, Schut said.
Breuklander said everyone thought she was fine because she didn't look like a drug user.
"I did not look like an addict, I did not function like an addict, but I was an addict and that's a scary thing,"
Breuklander said.
Meth "can cause you to look like you're highly efficient, highly effective in your daily living when in fact, you're
going downhill fast," she said.
Charbonneau and Breuklander have been treated at a substance abuse program at Mitchellville and now are mentors there.
Nearly 100 women are either in the inpatient care program or in after care, which helps prepare inmates for their return
to the outside world.
Women spend their day in classes, therapy groups and live in a communal environment - all in one room. The treatment
is peer led: they give each other push ups - congratulating each other for good behavior - and pull ups - telling each
other when they do something wrong.
Breuklander is grateful to the program, but has regrets.
"I have three children. I have missed two of their high school graduations. I've missed their birthdays, I've missed
important things in their life," she said. "It ruined my life."
CDC: Teenagers Using More Cocaine
By JUSTIN BACHMAN .c The Associated Press
ATLANTA (June 28) - Injury and violence-related behaviors among teenagers have fallen, but more teens are using cocaine
and regularly smoking and drinking, according to a recent survey.
The Centers for Disease Control and Prevention examined the behavior of 13,600 high school students from across the
country for the annual survey, which was released Thursday.
Nearly half of the teens surveyed said they'd consumed more than one alcoholic beverage more than once in the month
before the survey. But an increasing number are also wearing seat belts and refusing to ride with a driver who's been
drinking.
The number of teenagers who said they had tried cocaine in their lifetime rose to 9.4 percent, up from 5.9 percent
in 1991. About 4.2 percent of students said they had used cocaine in the past 30 days, up from 1.7 percent in 1991.
``We still have plenty of work to do,'' said Laura Kann, a researcher with the CDC's National Center for Chronic Disease
Prevention and Health Promotion.
About 46 percent of teenagers said they'd had sex, down from 54 percent in the 1991 survey. The percentage of sexually
active teenagers who had used a condom increased from 46 percent to 58 percent from 1991 to 1999, but remained at 58
percent through 2001.
The findings point to a failure of ``abstinence-only'' sex-education programs favored by the Bush administration,
said James Wagoner, president of Advocates for Youth, a Washington nonprofit group that supports both abstinence and
birth-control education for teenagers.
``The implication is clear and yet, the current administration ignores it. If you give young people information about
how to protect themselves, they use it,'' Wagoner said in a statement.
Other findings from the CDC survey:
The number of teenagers who said they never or rarely wore a seat belt fell from 25.9 percent to 14.1 percent.
The number of teenagers who said they rode with a driver who had been drinking fell from 39.9 percent to 30.7 percent.
The percentage of teenagers in daily physical education class fell from 41.6 percent in 1991 to 32.2 percent a decade
later.
The percentage of students who carried a weapon decreased from 26.1 percent in 1991 to 17.4 percent in 2001.
06/28/02 02:10 EDT
Gene Glitches Link Pot with Schizophrenia United Press International - July 01, 2002 OKAYAMA, Japan, Jul 01, 2002
(United Press International via COMTEX) -- Genetic anomalies tied with marijuana-activated brain chemicals appear linked
to schizophrenia, Japanese researchers report.
"This result provides genetic evidence that marijuana use can result in schizophrenia or a significantly increased
risk of schizophrenia," lead researcher Hiroshi Ujike, a clinical psychiatrist at Okayama University, told United Press
International.
Schizophrenia is one of the greatest mental health challenges in the world, affecting roughly one of every 100 people
and filling about a quarter of all hospital beds in the United States. For years, clinical scientists have known that
abusing marijuana, also known as cannabis, can trigger hallucinations and delusions similar to symptoms often found
in schizophrenia. Prior studies also show that cannabis used before age 18 raises the risk of schizophrenia six-fold.
The hallucinogenic properties of marijuana, the researchers explained, are linked to a biochemical found abundantly
in the brain. The chemical, called cannabinoid receptor protein, studs the surfaces of brain cells and latches onto
the active chemical within marijuana known as THC.
"These sites are where marijuana acts on the brain," Ujike said.
Ujike and his team examined the gene for the marijuana receptor in 121 Japanese patients with schizophrenia and an
average age of 44. When they compared this gene in schizophrenics with the same gene in 148 normal men and woman of
the same average age, they found distinct abnormalities in DNA sequences called nucleotides among the schizophrenics.
Some of their nucleotides in the marijuana receptor gene appeared significantly more often than normal while others appeared
less frequency.
"This finding is the first to report a potential abnormality of the cannabinoid system in schizophrenia," said clinical
neuroscientist Carol Tamminga at the University of Maryland in College Park. "The importance of a finding here cannot
be overstated, in that it would form a tissue target for drug development and allow targeted treatments to emerge for
the illness."
It appears malfunctions in the brain's marijuana-linked circuitry may make one vulnerable to schizophrenia, Ujike
said. This holds especially true for a condition called hebephrenic schizophrenia, which is marked by deterioration
of personality, senseless laughter, disorganized thought and lack of motivation. These symptoms are similar to psychotic
behavior sometimes triggered by severe cannabis abuse, which could mean the marijuana receptors in schizophrenics are far
more active than they should be.
Ujike stressed there is no evidence yet these genetic abnormalities can affect how the marijuana receptor actually
acts in the brain. "We would also like to replicate our findings with different ethnic populations and more people,"
he added.
The researchers described their findings in the scientific journal Molecular Psychiatry.
(Reported by Charles Choi, UPI Science News, in New York)
SOURCE: Caron Foundation Major Differences in Addiction and Treatment Between Men and Women, Caron Foundation Reports
WERNERSVILLE, Pa., June 17 /PRNewswire/ -- With increased availability of illegal drugs and acceptability of women
drinking and using drugs, women are approaching a dubious form of gender equality, according to "Women & Addiction:
Gender Issues in Abuse and Treatment," a research report issued by the Caron Foundation, one of the nation's most respected
alcohol and drug addiction treatment centers. The full report, which includes a self test for women on alcohol and substance
abuse, is available at http://www.caron.org.
"Addiction doesn't have the face most Americans imagine when they think of an alcoholic or drug addict," commented
Susan Merle Gordon, Ph.D., Caron Foundation research director and author of the report. "We have learned that many women
fail to recognize their own addiction, probably because they don't see themselves as the stereotypical addict."
Drug use among women is increasing at higher rates than among men. Teenage girls abuse drugs and alcohol at the same
rate as boys, but the rate of increased use among girls exceeds that of boys. Once initiated, women tend to become addicted
more quickly than men, and to experience resulting medical problems sooner.
The report also covers the importance of relationships to women and how they can have a negative impact. Women are
likely to be introduced to drugs and alcohol by men with whom they have an intimate relationship, while men are influenced
by male friends or acquaintances. Abuse and trauma, often inflicted by a family member, make girls and women more vulnerable
to addiction. Women tend to be supportive of men in treatment, but male partners are not as likely to be supportive
of women in treatment.
"Addiction is a deadly disease," said Gordon. Women are more vulnerable to the negative affects of drugs and alcohol
abuse than men. Four times as many women will die from addiction-related illness than breast cancer. Alcoholic women
are five times more likely to attempt suicide than other women.
"Fortunately, research shows that addiction treatment works, although only 30% of addicted women get treatment," said
Gordon. Those who are treated in women-only treatment programs are more likely to complete treatment than those in mixed-gender
programs, and have a better recovery rate.
The report also covers substance abuse among working women, its impact on pregnancy and parenting, and issues for
teenage girls.
For a hard copy of the report, email dtomaszewski@caronfoundation.org, call 800 678-2332 Ext. 2288, or write to Dianne Tomaszewski, Caron Foundation, Galen Hall Road, Wernersville, PA 19565.
First Study of Midwest Teen-age Runaways Reveals Disturbing Data on Abuse, Mental Health
Lincoln, (Neb.), July 1, 2002 -- Teen-age runaways in the Midwest report that physical and sexual abuse were often
the reason that they left home, according to the most comprehensive ongoing survey to-date of homeless runaway youths
in eight Midwestern cities.
"We're not seeing a lot of functional homes sending kids out onto the streets," said Kurt Johnson, a research sociologist
at the University of Nebraska-Lincoln, which is conducting the Midwest Longitudinal Study of Homeless Adolescents.
"They come from a home life that's not very rosy and they decide to go or are tossed onto the street," Johnson said.
"The questions our research are trying to answer deal with not only how these teen-agers ended up on the street, but
what the street then does to them."
According to the three-year, $3 million survey of 455 runaway teens spearheaded by sociologists at the University
of Nebraska-Lincoln, runaways are far more likely than "normal" teens to suffer from mental disorders like conduct disorder,
post-traumatic stress disorder, substance abuse and severe depression.
For example, 74 percent of male runaways and 57 percent of females in the study have conduct disorder, compared to
about 15 percent of the general teen population, Johnson said. Also, 23 percent of males and 43 percent of females show
symptoms of post-traumatic stress disorder, a finding Johnson calls "shocking."
"These people were involved or connected with gut-wrenching experiences, including sexual abuse and physical abuse,"
said Johnson, who collects the data from eight full-time survey outreach workers who visit shelters, the streets, bus
stations, malls and other areas where runaways hang out, to interview them periodically over three years.
The ongoing research involves eight Midwestern cities: Lincoln and Omaha, Neb.; Des Moines, Iowa City and Cedar Rapids,
Iowa; Wichita, Kan.; and St. Louis and Kansas City, Mo. Of the surveyed teens in these cities, 55 are from Omaha, 111
from St. Louis, 60 from Des Moines, 60 from Lincoln, 49 from Wichita, 60 from Iowa City/Cedar Rapids, and 60 from Kansas
City. Forty-four percent are male and 56 percent female.
The survey is the brainchild of Les Whitbeck and Dan Hoyt, two UNL sociology professors who have made a career of
studying homeless teens. They are authors of "Nowhere to Grow: Homeless and Runaway Adolescents and Their Families,"
a book published in 1999 that resulted from a previous study of 600 runaways.
The current project is in its second year and has just released its first report. "The Midwest Longitudinal Study
of Homeless Adolescents" is being sent to agencies in the Midwest that work with runaway teens. The report contains
detailed information from interviews that the survey outreach workers conduct every three months with runaways who agree
to stay in touch over the three-year period, typically from age 16 to 19. About 65 percent of the initial group of 455
teens have stayed in touch with interviewers, who are in many cases one of the few adults who express interest in their
lives.
During the interviews, for which the teens are paid $25, Johnson said new insights are gained about the lives of these
teens. For example, there are different gradients of runaways, from "couch surfers" who leave home and sleep on the
sofas of friends and relatives before going back home, to hard-core runaways with their own subculture. Most runaways
stay within a 50-mile radius, although they will travel to other cities, especially "magnet" cities like Seattle or San Francisco,
Johnson said.
The study is important for a number of reasons, including troubling signs that runaway teens are poorly equipped for
adult life, Johnson said.
"Society should worry about what we're doing to these kids by letting them live on the street and should ask some
hard questions about why we're not helping them as much as we should be," he said.
A report summarizing findings from the Midwest Longitudinal Study of Homeless Adolescents is available, at www.mwhomeless.com. More detailed information is available based upon interview information on the following aspects of runaway life: Basic
demographics Family history Run history Suicide attempts and ideation Physical and mental health Diet and nutrition Subsistence strategies
Victimization and victimizing behaviors Social networks Sexuality and pregnancy Help-seeking behaviors Drug and alcohol
use Deviant peers School history and prosocial behaviors
Addiction May Be in the Mind HealthScout - July 08, 2002 MONDAY, July 8 (HealthScoutNews)-- People who want to
break a bad drug habit may have to do more than avoid the sights and sounds that remind them of their addiction.
For years, researchers have known that external cues affect addiction by building up drug tolerance, which makes people
need more and more of a drug to obtain the same effect.
However, internal cues are also at work, says a new study in the July issue of the Journal of Experimental Psychology:
Animal Behavior Processes. These early, internal cues prime the body to react as if the drug effect is imminent.
The finding points out that addiction may be a psychological phenomenon, not just a physiological one. In turn, that
could help those in treatment programs to kick illegal drug use, as well as help doctors prescribe potent painkillers
more safely.
"The important new finding is that part of the stimuli that elicits this learned response (to need more and more drug)
comes from early drug effects," says study author Shepard Siegel, a professor of psychology at McMaster University in
Hamilton, Ontario. These internal cues, he says, are as important as external ones.
In the study, Siegel and his colleagues gave rats infusions of morphine over several days, so the animals developed
tolerance to the pain-relieving effects. It takes a few minutes after infusion for the peak effect of a drug to occur.
The researchers hypothesized that every administration would pair the early effects of the drug with the peak effect,
and the animals would begin to associate the early effect with the later effect.
Next, they gave the animals a very small dose, about 10 percent of what they had been getting.
A dose that small usually has no effect, especially after animals are used to a larger one. However, these animals
responded as if a large dose was coming.
"The finding clearly shows that internal cues can be associated with addiction to a drug," Siegel says. "The finding
should have an effect on cue exposure therapy. Cue exposure therapy is a form of desensitization. It's used for cigarette,
drug and alcohol [cessation]."
Traditionally, therapists pay attention to external cues, such as a picture of a syringe. Now, the research suggests
they should also pay attention to internal cues.
The research may also explain why relapses to a drug habit can be possible even when a person is exposed to a small
dose, Siegel says. For instance, a recovering alcoholic may be vulnerable to a single drink because the body responds
to the drug onset cue with a full-blown craving, as if a large dose is coming, and binges.
Siegel suggests desensitization therapy should include small doses to better replicate how the body responds to stimuli.
The new research finding builds on a body of research on the role of learning in drug tolerance, says Mark E. Bouton,
a professor of psychology at the University of Vermont and editor of the journal, which is published by the American
Psychological Association.
Besides helping administrators of drug-cessation programs and prescribing physicians, the research could help those
fighting drug addiction because it shows there are many cues that can stimulate the urge to take drugs, Bouton says.
"Feeling the urge is not a sign of personal weakness," he adds. "Becoming aware of the cues that might be stimulating
the urge can only help."
What To Do
For information on drug abuse, visit the National Institute on Drug Abuse. For information on prescription drug use
and abuse, check out the U.S. Food and Drug Administration.
The Smoke That Terrifies, Satisfies, Mystifies: Marijuana Neither Horrifying 'Gateway' Drug Nor Innocuous Cure-All,
Says USC Researcher
AScribe Newswire - July 19, 2002 LOS ANGELES, July 19 (AScribe Newswire) -- It is the world's most commonly used illicit
drug, and perhaps the most controversial of all substances. Marijuana has been at the center of debate for decades,
with equal numbers calling for its legalization and ban.
In his new book, "Understanding Marijuana" (Oxford University Press, 2002) Mitch Earleywine, an associate professor
of psychology at the University of Southern California, attempts to sort out myths and facts about the drug. After analyzing
some 500 studies, Earleywine's ultimate conclusion is mixed - marijuana is neither completely harmless nor tragically toxic.
"The common human desire is to split the world into two categories," said Earleywine, an expert on substance abuse
and personality "Decisions are easier when everything is black or white. Yet the world remains in glorious color."
Earleywine looks at the history of medical and recreational marijuana use, cannabis pharmacology, health effects and
treatment.
After examining studies dating from 1681 to 2001, Earleywine has arrived at a number of conclusions, including:
- Daily marijuana use alters brain function. About 10 percent of regular users develop troubles ranging from memory
lapses and paranoia to an increased tolerance to the drug.
- Marijuana does not spur aggressive behavior or impede motivation.
- Marijuana is not a gateway drug and is less harmful than tobacco and alcohol. Less than 1 percent of marijuana users
try heroin.
- While marijuana does help glaucoma, it is not as effective as recently developed Canasol eye drops, which do not
cause any intoxication and last much longer.
- Users cannot learn new material while they are high on marijuana. Studies show an impairment in "free recall" memory
and find that users are unable to separate relevant from irrelevant stimuli.
- Unlike alcohol or aspirin, marijuana has never been known to cause a lethal overdose.
- Between 200 million and 300 million people claim to have tried the drug at least once, with far fewer identifying
as regular users. In the United States, fewer than 5 percent of Americans report using the drug every week.
Earleywine cautions that an incomplete reading of research can support any argument for or against marijuana. After
examining the studies, he found that some researchers ignored crucial information and data in their final analyses.
For example, he said, studies slanted against marijuana legalization mention that tetrahydrocannabinol (THC), the
main active chemical in marijuana, often appears in the blood of people involved in auto accidents; But the studies fail
to mention that most of these people also had high blood-alcohol levels.
Similarly, studies slanted in favor of marijuana legalization cite a large study that showed no sign of memory
problems in chronic marijuana smokers. However, they neglect to mention that the tests were so easy that even a young
child could perform them.
"Researchers' interpretations may tell more about their own biases than they do about the data," Earleywine said.
"I have tried to avoid this problem by providing appropriate detail about research so that readers can interpret results
for themselves."
Earleywine said that some research concludes that marijuana prohibition may cost more than it saves. More than 500,000
people are arrested each year for offenses related to cannabis.
"Whatever the benefits of marijuana prohibition, the laws also generate costs. These include the price of law enforcement
and incarceration. In addition, the taxes that a legal marijuana market could generate are also lost," Earleywine said.
The federal government spends $15.7 billion annually on drug prohibition, while state and local governments spend
approximately $16 billion annually enforcing drug laws, for a total of nearly $32 billion. Approximately 43 percent
(642,000) of the 1.5 million drug arrests in 1996 were for marijuana offenses. If all arrests were equally costly, America
spent $13.7 billion on marijuana arrests - approximately $21,400 for each one, said the researcher.
"Some arrests undoubtedly cost more than others," Earleywine said. "Even if marijuana enforcement cost only half this
amount, Americans have clearly spent billions in an attempt to eradicate this drug, and will likely continue to do so."
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