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.

The report is available on the web at http://www.oas.samhsa.gov.

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

URL: http://www.samhsa.gov http://www.prnewswire.com

 

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.

 

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>

National Institutes of Health: National Institute on Alcohol and Alcohol
Abuse NIAAA: http://www.niaaa.nih.gov/

Dr. Sally Satel <http://www.sallysatelmd.com/html/about_the_author.html>
<http://www.aei.org/satel>

Stanton Peele http://www.peele.net/

Dr. Jeffrey Schaler http://www.schaler.net/

Brookhaven National Laboratories http://www.bnl.gov/pet/studies.htm

Dr. Stephen L. Dewey
<http://www.chemistry.bnl.gov/SciandTech/BCIN/PET/dewey.htm>

Medical College of Wisconsin Functional Imaging Research Center
<http://www.firc.mcw.edu/>

Dr. Michael Nader, Wake Forest University School of Medicine
http://www.wfubmc.edu/physpharm/faculty/nader

Harvard researcher Tristan Darland
<http://www.pnas.org/cgi/content/full/98/20/11691>

James Frey, author, A Million Little Pieces
<http://search.barnesandnoble.com/booksearch/isbninquiry.asp?userid=2UXZG8MV
WZ&isbn=0385507755 >

"What works? A summary of Alcohol Treatment Research," Reid Hester, William
Miller http://www.behaviortherapy.com/whatworks.htm

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.edu
607-777-7164 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.

 

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.

See the rest at <http://www.timesonline.co.uk/article/0,,8123-954615,00.html>

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.

 

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:

White House Office of National Drug Control:
http://www.whitehousedrugpolicy.gov

Monitoring the Future: http://monitoringthefuture.org

 

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

 

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.

For more information about the college, visit www.uic.edu/jaddams/college/

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."

On the Net: Veterans Affairs: www.va.gov National Coalition of
Homeless Veterans: www.nchv.org

Hoosier Veterans Assistance Foundation: www.hvaf.org

 

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

Office, +1-301-443-8956
URL: http://www.samhsa.gov http://www.prnewswire.com

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 ).

Findings from the 2002 National Survey on Drug Use and Health are available
on the Web at http://www.DrugAbuseStatistics.samhsa.gov
Note: All HHS press releases, fact sheets and other press materials are
available at http://www.hhs.gov/news .
http://www.usnewswire.com/

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.

Visit the Iowa Consortium for Substance Abuse and Evaluation online
at http://iconsortium.subst-abuse.uiowa.edu .

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

 

"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.edu
NICOTINE 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.

 

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.de
49-551-3899628 (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.edu
Researchers 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.

For more information about the college, visit www.uic.edu/jaddams/college/

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.

- US Department of Education (DEd): "Exemplary Programs" details
programs with proven records of success. Go to:
www.ed.gov/PressReleases/10-1996/sdfsntl.html.

- 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.pdf
Available 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.

"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.

For more information on the survey, go to http://www.samhsa.gov.

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

 

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.

 

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.

MARIJUANA USE INCREASES RISK OF MI IN MIDDLE-AGED PEOPLE
Middle-aged marijuana smokers are at significantly increased risk
of
myocardial infarction (MI), especially during the hour immediately
following smoking, according to a report published in the June 12th
issue
of Circulation: Journal of the American Heart Association.
http://psychiatry.medscape.com/38929.rhtml?srcmp=psy-061501
<a href="
http://psychiatry.medscape.com/38929.rhtml?srcmp=psy-061501"> Read
it Here</a>

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.

 

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.