2. February 2012 by stationmanager.

Teenage drinking and cigarette smoking is at a historic low, but marijuana use and prescription drug abuse continue at high rates, according to a new report looking at trends among teens.

And there’s a new substance raising concerns.

For the first time the study looked at the use of synthetic marijuana, also known as Spice or K2, by 12th graders. More than 11% admitted using it over the last year, information Gil Kerlikoeske, Director of the White House Office of National Drug Control Policy (ONDCP), calls shocking.

“One in nine 12th graders in America have used synthetic marijuana in the last year. Spice and K2 now rank as the second most frequently used illegal drug among high school seniors, second only to marijuana,” Kerlikowske said. “Make no mistake. These drugs are dangerous and can cause serious harm. Poison control center data across America have shown as substantial rise in the number of calls from victims suffering serious consequences from these synthetic drugs.”

ONDCP says poison control centers have fielded nearly 6,000 calls so far this year - already double last year’s number.

According to Kerlikowske, up until a few months ago synthetic marijuana was being sold legally as an alternative to marijuana in convenience stores across the country. That’s when the Drug Enforcement Administration banned the sale of the chemicals used to make it.

Now, he’s calling on parents to talk to their kids about the serious consequences of marijuana, K2 and Spice use.

“We must be clear with our young people,” says Kerlikowske. “Smoked marijuana is not an FDA approved medicine and the National Institute of Health has long documented the harms of marijuana use. Science shows it is addictive. Research shows it impairs driving. Studies show it can degrade academic performance.”

Kerlikowske says ONDCP is working on a federal response to Spice/K2 that includes working with public health agencies to share data and coordinate a response. They are also working with Congress to get new laws passed that will ban these drugs.

The Monitoring the Future (MTF) survey has been tracking students from secondary school to young adults for nearly four decades, measuring their drug, alcohol and cigarette use. Each year the study chronicles the behaviors and attitudes of nearly 50,000 8th, 10th and 12th graders.

Researchers say the drop in alcohol and cigarette use has occurred gradually for a number of years.

“That cigarette use has continued to decline to historically low rates is welcome news given our concerns that decline may have slowed or stalled in recent years,” said NIDA Director Dr. Nora Volkow, Director, National Institute on Drug Abuse who funded the study. “Tobacco and alcohol cause more disability and death in this country than any other drug , so we are heartened that efforts made by the public health community to educate teens and prevent drug abuse seem to be having an impact.”

Fourteen years ago about 75% of 12th-graders admitted drinking alcohol. In 2011, 63.5% say they did. This year almost 27% of eighth-graders surveyed used alcohol compared to approximately 47% in 1994. Over the last 5 years, binge drinking - defined as having five or more drinks in a row over a two-week period - fell among all three grades.

Teen smoking fell in all three grades as well. A little more than 10% of 12th graders say they smoke daily - down significantly from 24.6% in 1997; while just 2.4% of 8th graders reported smoking every day.

“This is very good news for the health and longevity of these young people,” states Lloyd Johnston, research scientist at the University of Michigan and the principal investigator of the study. “Even a reduction of only one percentage point can translate into thousands of premature deaths being prevented.”

Teen smoking peaked in 1996-1997. Since then, the levels have dropped significantly - 71% for 8th graders, 61% in 10th graders and 49% in seniors. In fact, the number of students who have tried smoking at all fell dramatically.

Marijuana use, on the other hand, continues to rise at a steady pace, researchers found. More than 36% of seniors reported using the drug over the past year; almost 7% say they use it daily. Researchers say the rise in use is tied to the perception that the drug is not harmful.

The study also tracked prescription drug trends. Use of the painkiller Vicodin dropped among sophomores, and remained unchanged - but at levels considered high - among seniors.

Researchers say the fact that OxyContin use has remained steady for all three grades over the last five years is cause for concern. Another cause for alarm - amphetamine use is up among high school seniors. They saw no change in the use of Adderall and Ritalin, both ADHD medications, over the last year. But they did see a considerable drop in the number of 8th graders abusing over-the-counter cough medication.

The study was funded by the National Institute on Drug Abuse, part of the National Institutes of Health. Volkow says the institute is launching an updated prescription drug section on their teen website in an effort to educate teenagers about the dangers of prescription drug abuse.

“Teens can go to our PEERx pages to find interactive videos and other tools that help them make healthy decisions and understand the risks of abusing prescription drugs.”

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27. January 2012 by stationmanager.

 Genes that contribute to high alcohol consumption are not the same as those that predispose to alcoholism, new research suggests.

Investigators from the University of Colorado, Denver, found that in rats and in humans, genetic make-up may predispose individuals to drink more but may not increase the genetic risk for alcoholism. This study pinpoints genetic pathways and genes associated with levels of alcohol consumption but not with alcohol dependence.

“The main impact of our findings with regard to human alcohol consumption and alcoholism is that our studies dissociate the brain mechanisms that control levels of alcohol consumption from those mechanisms that produce psychiatrically defined alcoholism,” principal investigator Boris Tabakoff, PhD.

“The definition and characteristics of alcoholism primarily involve a state in which the individual cannot reduce his/her drinking, cannot abstain from drinking, and in which the person’s life becomes centered on obtaining and drinking alcohol. Many lay individuals, and even those in the medical profession, equate a high amount of alcohol drinking with alcoholism. Our studies indicate that the genetic predisposition to drinking high levels of alcohol in a controlled manner is different than those genetic predisposing factors that produce loss of control/drinking. Thus, high levels of alcohol intake do not necessarily equate to alcohol dependence,” he added.

Disorders Not the Same

However, Dr. Tabakoff also noted that research by his team does indicate that high levels of alcohol intake are necessary for the neural changes that lead to dependence. “Thus, alcohol intake can be considered an ‘environmental predisposing factor’ to alcohol dependence development. In a nutshell, levels of alcohol intake are not biologically the same as alcohol dependence,” he said.

The research team used rats to identify the genetic pathways affecting alcohol drinking behavior. They found that the rats’ drinking behavior was linked to the pleasure and reward pathways in the brain and was also linked to some of the same genetic systems that control satiety and appetite for food.

Next, the researchers directly compared genes involved in these alcohol-associated pathways in rats with the human versions of these genes in 2 male study groups from Montreal, Canada, and Sydney, Australia, to identify common genetic factors linked to alcohol use across species. This analysis showed that that genes identified as contributors to drinking behavior in the tested populations were not the same as the genes found to predispose to alcohol dependence.

Eating and Drinking Mechanisms Linked

“The implications for alcoholism research are fairly significant. We can say that the study of alcohol drinking per se in animals, including humans, may not produce appropriate insights into the determinants of alcoholism. Additionally, if one is trying to develop medications to treat alcoholism using animal models that simply measure drinking in nondependent animals, the studies may not produce results that would indicate efficacy of a drug in a situation where an individual is alcohol dependent,” said Dr. Tabakoff.

The researchers were surprised at the similarity of the alcohol-related pathways to those that normally control ingestive behaviors in general. “Since alcohol has caloric value, part of the rewarding property of alcohol in a nondependent individual may have to do with systems that have been developed to monitor and maintain the body’s energy needs,” he said.

This raises the intriguing question of whether medications that were developed for control of appetite for food might be useful for controlling an individual’s drinking levels.

“Our studies do strongly indicate that we should be looking at alcohol consumption and alcohol dependence differently, both from the perspective of biological drives and mechanisms and, as well, for developing treatment strategies — be they medications or psychotherapy,” Dr. Tabakoff said.

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18. January 2012 by stationmanager.

 A family history of alcoholism is a risk factor for the development of alcohol addiction, but it does not predict remission from the disorder, according to a study presented here at the American Psychiatric Association (APA)  Annual Meeting.

Although subjects in the study were followed for 40 years, researchers from the University of Kansas Medical Center, in Kansas City, Kansas, and the University of Copenhagen, in Denmark, were unable to find a link between a positive family history of alcoholism and whether or not subjects went into recovery. But 9 methods of assessing family history were able to predict the development of an alcohol-use disorder by the age of 40.

“Family history predicted who would get sick but not who would get better,” study investigator Elizabeth Penick, PhD, from the University of Kansas Medical Center. Dr. Penick added that the researchers found that other factors — personality characteristics rather than family history — are more important in predicting remission. “Our research has shown that 2 basic measures predict who will and will not go into remission — impulse discontrol and mild cognitive dysfunction,” she said.

Worse Cases More Likely to Recover

The study used a cohort of 9182 people born from 1959 to 1961 in Denmark. When the subjects were 17 years old, the researchers conducted a search for 8440 fathers in the Central Psychiatric Register and local alcoholism treatment clinics in Copenhagen to find those who had been treated for alcoholism. High-risk sons of alcoholic fathers — 220 in all — were followed for 40 years, as were 109 “low-risk” matched controls with no family history of dependence or abuse.

Subjects were assessed at ages 20, 30, and 40 years with a series of structured interviews, psychometric tests, and an examination by a senior psychiatrist. Nine methods of defining familial alcoholism were derived from the data, and all were strongly correlated with each other and with the development of alcohol dependence or alcohol abuse by age 40.

Of the 52 men who developed alcohol dependence, 58% recovered and went into remission. Of the 35 men who abused alcohol, 88% experienced a remission.

“Those who were sicker from alcoholism tended to get better,” Dr. Penick said. The average duration of remission for those who recovered from alcoholism was 11.1 years, she added.

Genetics of Alcoholism “Extremely Complex”

“We know that heredity is a good predictor of onset, and it can tell you who is at increased risk for alcoholism. Yet it doesn’t tell you what happens afterward,” said Mark Willenbring, MD, director of the division of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism.

Dr. Willenbring noted that those with a family history of alcoholism are at risk for a variety of psychiatric disorders, including alcohol abuse and dependence. Research has found that sons of alcoholic fathers are more likely to show a reduced response to alcohol — they can “hold their liquor.”

This characteristic, combined with behavioral discontrol, is a predictor for the later development of alcohol dependence. “But these characteristics can also predict depression, antisocial behavior, and eating disorders,” Dr. Willenbring said.

Dr. Willenbring noted that the genetics of alcoholism is extremely complex, and there may be multiple genes involved in the development of alcoholism. “It’s very difficult to understand what’s inherited and what comes about through environment,” he said.

At the same time, he added, there are still gaps in research knowledge about what predicts remission among those who develop alcohol dependence or abuse. “It may be different personality factors, but it may also revolve around how strong the person’s social networks are,” he said.

The study was funded by grants from the National Institute on Alcohol Abuse and Alcoholism,

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11. January 2012 by stationmanager.

Consumption of highly caffeinated energy drinks may be associated with risks of heavy drinking and alcohol dependence, new research suggests. These heavily caffeinated drinks are increasingly popular with college students, who use them to help stay awake at night while they cram for exams, said Amelia M. Arria, PhD, director of the Center on Young Adult Health and Development at the University of Maryland School of Public Health in College Park.Also growing in popularity is the trend of using energy drinks together with alcohol.

“These drinks are being heavily marketed to youngsters. You can tell by the colorful packaging and type of ads that are on TV. But we don’t know yet if there are possible adverse effects from caffeine intoxication or from the high caloric content from sugars in these drinks. And using them together with alcohol may be a very dangerous mix,” she said in an interview with Medscape Medical News.The study is published online November 12 in Alcoholism: Clinical & Experimental Research.

Dangerous Combination

Prompted by prior research that highlighted the dangers of combining energy drinks with alcohol, Dr. Arria and colleagues investigated the extent to which energy drink use might pose additional risk for alcohol dependence over and above that from known risk factors.They collected data from personal interviews with 1,097 fourth-year college students (46% male, 73% white, aged 20 – 23 years) from a large public university and measured alcohol dependence according to Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria.They found that 51.3% of the students were “low frequency” energy drink users, who drank from 1 to 51 days in the past year, and 10.1% were “high-frequency” users, who drank more than 52 days. They also found that high-frequency users drank alcohol more frequently (141.6 vs 103.1 days) and in higher quantities (6.15 vs 4.64 drinks per typical drinking day) than low-frequency energy drink users.Red Bull was the most popular of the energy drinks, consumed by 82% of the users.The study found that high-frequency energy drink users were at a significantly greater risk for alcohol dependence compared with nonusers (adjusted odds ratio [AOR], 2.40; 95% confidence interval [CI], 1.27 – 4.56; P = .007) and with low-frequency users (AOR, 1.86; 95% CI, 1.10 – 3.14; P = .020).The association held after adjusting for race, socioeconomic status, depressive symptoms, parental history of alcohol or drug problems, and childhood conduct problems. Mechanisms Unclear The investigators also found that low-frequency energy drink users did not differ from nonusers on their risk for alcohol dependence.The study is an associational study and not a prospective one and therefore cannot attribute energy drink consumption as a cause of alcohol dependence, Dr. Arria said.“But it does not close out the possibility that there is some causal association that we need to look into further. Energy drinks could make alcohol more reinforcing, so that you drink more, and then you have more problems, and then you have more craving for alcohol.“There are a lot of mechanisms between the use of energy drinks and the possibility of alcohol dependence, and we’re not completely clear of those mechanisms yet. That’s another study. We are trying to get federal funding to do the prospective analyses to see whether or not the frequent consumption of energy drinks comes beforehand.”The results of the study also give clinicians one more thing to be vigilant about with their teen and young adult patients.“It’s important for clinicians to recognize that energy drinks are now part of a mix of substances that are routinely consumed by adolescent and young adult populations, so they should have a greater awareness and vigilance that these drinks may be contributing to some symptoms, such as palpitations and anxiety, that they may be seeing in this age group,” she said.

Important Questions Remain

Weighing in with his opinion, Itai Danovitch, MD, director of the Addiction Psychiatry Clinical Service at Cedars-Sinai Medical Center in Los Angeles, California, said that the study “shows very nicely that there is an association between caffeine consumption in the context of energy drinks and alcohol dependence” mostly in a cohort of white college seniors.“What it doesn’t reveal is an answer to the question, ‘Is there a causal relationship?’ Does exposure to energy drinks and to caffeine increase the risk of alcohol dependence? Or is this due to a common set of risk factors which might drive people to experiment and use more energy drinks and binge?” Dr. Danovitch said.Another limitation of the study is that it does not differentiate between use of energy drinks by themselves and the use of energy drinks used as mixers with alcohol.“There’s a trend now for kids to use energy drinks as the mixer with alcohol. They have vodkas and Red Bulls. And if that’s the context in which kids who drink a lot are also consuming a lot of energy drinks, then there’s a bit of a confound,” he said.  “The caffeine counteracts the sedating effects of the alcohol so you can stay up longer and drink harder. If you know that you are going to binge and you don’t want to be out by 10:30 pm, then it makes sense to mix with a caffeinated beverage. That’s a really important thing to sort out.”Dr. Danovitch agrees that more studies are needed to clarify the association and develop more evidence of causality between the two.He added that more research is needed on the health effects of high-dose caffeine exposure on young people.“We know that youth have different vulnerabilities than adults and that studies of exposure to medication in adults do not always apply to kids whose brains aren’t mature. So we need to know, given that kids are now getting exposed to doses of hundreds of milligrams of caffeine in coffee and energy drinks, if that has any deleterious effects.” Finally, people who consume energy drinks and alcohol together need to be aware of the risks.”Particularly if caffeine exposure allows people to continue to be drunk while having lost their subjective perception of being intoxicated and increase their bad judgment and risky behavior, then they need to be aware of that. Proper labeling and education about risks is really key,” Dr. Danovitch said.

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3. January 2012 by stationmanager.

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27. December 2011 by stationmanager.

Clinical Context

The US Preventive Services Task Force recommends screening adults for alcohol misuse in primary care settings, but many clinicians struggle with the very definition of alcohol misuse. The National Institute on Alcohol Abuse and Alcoholism defines at-risk alcohol use among women as more than 3 drinks per occasion or more than 7 drinks per week. In addition, any amount of drinking during pregnancy is considered at-risk alcohol use. Binge drinking is defined as more than 3 drinks per occasion, whereas moderate drinking is defined as 1 alcoholic beverage per day.Women are at particularly high risk for negative consequences from alcohol misuse. The current Committee Opinion from the American College of Obstetrics and Gynecology (ACOG) examines means to detect alcohol misuse among women and how to provide the best care for women with at-risk alcohol use.

Study Synopsis and Perspective

Women should be screened for alcohol use at least annually and during the first trimester of pregnancy, according to new recommendations from ACOG. The ACOG Committee Opinion, entitled “At-Risk Drinking and Alcohol Dependence: Obstetric and Gynecologic Implications” is published in the August 2011 issue of Obstetrics & Gynecology.“Alcohol is so ubiquitous in our society, many women may be surprised to learn that their drinking exceeds a safe level. They may consider their alcohol use normal because it’s similar to the drinking patterns of their family, friends, and social circles,” said Maureen G. Phipps, MD, chair of The College’s Committee on Health Care for Underserved Women. “But because of our physiology, we don’t process alcohol the same way men do, and too much can wreak havoc on our bodies. The risks are amplified in women who are or may become pregnant, because the effects of alcohol exposure on a fetus can be harmful.”The Committee Opinion defines at-risk alcohol use as more than 7 drinks per week, binge drinking (> 3 drinks per occasion), or any amount of alcohol intake among women who are pregnant or at risk for pregnancy. These ACOG guidelines offer suggestions for how healthcare providers can discuss alcohol use with their patients, screening tests to detect at-risk drinking patterns, information on when and how to refer alcohol-dependent women for professional treatment, a chart of standard drink measurements, and other useful resources.“Ob-gyns have an opportunity to educate women on making safe and healthy choices about alcohol intake,” Dr. Phipps said.Obstetrician-gynecologists play a key role in screening women for at-risk alcohol use and in offering brief intervention, patient education, and treatment referral when needed. Women who are not physically addicted to alcohol may benefit from brief intervention and motivational interviewing incorporated into an office visit. Pregnant women and those at risk for pregnancy should receive clear, compelling advice to avoid alcohol use, and assistance in becoming abstinent or effective contraception. Healthcare providers should advise women that low-level alcohol drinking in early pregnancy is not an indication for pregnancy termination.Among women in the United States, alcohol-related mortality is the third leading cause of preventable death. The adverse effects of high levels of alcohol use include reduced fertility, menstrual disorders, injuries, increased risk for some cancers, seizures, and malnutrition. Psychosocial problems may include loss of income, child neglect or abuse, impaired judgment, driving under the influence, and depression. Alcohol is teratogenic, and prenatal exposure may result in growth impairment, facial abnormalities, central nervous system and/or intellectual impairment, and behavioral disorders.“Women who develop alcohol or substance use dependence are often more likely than men to deny that they have a problem and to minimize the problems associated with their use,” the Committee Opinion states. “However, when they do seek help for the problem, it often is from their primary care providers. Importantly, most women who use alcohol at risk levels have no signs on physical examination. A detailed medical history obtained by a trusted clinician remains the most sensitive means of detecting alcohol abuse.”

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