6. November 2011 by stationmanager.

Teens whose parents drink are more likely to drive under the influence (DUI) when they are adults compared with children with non-drinking parents, a new study suggests. The study found the risk of DUI was increased even if parents’ drinking was moderate.

The study found 6 percent of teenagers whose parents drank, even just once in awhile, said they drove under the influence when they were 21, compared with 2 percent of those whose parents did not drink, HealthDay reports.

The results are published in the journal Accident Analysis & Prevention.

“The main idea is that parents’ alcohol use has an effect on their kids’ behavior,” study lead author, Mildred Maldonado-Molina of the University of Florida College of Medicine, said in a university news release. “It’s important for parents to know that their behavior has an effect not only at that developmental age when their kids are adolescents, but also on their future behavior as young adults.”

The researchers surveyed almost 10,000 teens and their parents, and conducted a second survey of the same group seven years later. The study found parents had more influence on their children’s driving than the teens’ friends did, but peer pressure did have an effect. Teens with friends who drink alcohol are more likely to drive under the influence, even when their parents do not drink at home, the study found. Teens are at highest risk when they have both friends and parents who drink alcohol: 11 percent of these teens said they drove under the influence when they were in their 20s.

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26. October 2011 by stationmanager.

In the United States today, there are more than two million jail and prison inmates, of whom about 15 percent have histories of heroin dependence. Few inmates receive drug abuse treatment while incarcerated or immediately upon release. Research has shown that this population, once released from incarceration, is at high risk of relapse to heroin use, criminal behavior, HIV infection and of overdose death, resulting in a terrible toll on the individuals, their families and our communities.

The World Health Organization supports the international standard that prisoners have the right to access the health services that would be available to them in the community. Health care in prisons is then a human rights issue and treating drug-dependent prisoners in jail and prison is consistent with the spirit of that standard. However, the correctional systems in the U.S. have been slow to embrace this notion and have shown even less comfort with providing medications to treat addictive disorders.

There are now several FDA-approved medications available in the U.S. to treat opioid dependence. Methadone has been available to treat opiate dependence since the early 1970s. Buprenorphine (Subutex and Suboxone) has been available since 2003. Oral naltrexone, an opioid antagonist, has been available since 1984 and the recently-approved Vivitrol, a long-acting, injectable form of naltrexone, is now available. Unfortunately, these medications are infrequently provided to opioid-dependent adults in U.S. jails and prisons and in the community under parole or probation supervision.

There are multiple barriers impeding the improved treatment of opioid-dependent inmates, probationers and parolees. There is an inherent contradiction between custodial and treatment goals. Moreover, many correctional officials may not be aware of the strong evidence supporting the effectiveness of medications in reducing drug use and criminal activity. They may be philosophically opposed to the use of medications or reluctant to increase their budgets to include medical services for addiction treatment. Moreover, many corrections officials in charge of jails and prisons feel their responsibilities end when the inmate is released from their facility.

The question can then be asked: How can change be affected in the criminal justice system to improve the treatment of opioid-dependent prisoners? The answer may lie in current research, the majority of which is funded by the National Institute on Drug Abuse (NIDA).

Two different approaches are being used. The first is to test medications in opioid-dependent prisoners and those newly released from jail or prison. A recent study by Dr. Timothy Kinlock and colleagues at the Friends Research Institute established that adding methadone to counseling in prison increased the likelihood that a prisoner, upon release, would continue to receive drug abuse treatment in the community, reaping the benefits of this medication; e.g., reduced risk of drug use and of overdose. An ongoing multi-site study led by Dr. Charles O’Brien at the University of Pennsylvania is underway among adult probationers and parolees to evaluate the effectiveness of long-acting naltrexone, which protects from relapse and overdose for one month. The research team at Friends Research Institute is also conducting a study of the effectiveness of Suboxone in prisoners with histories of opioid dependence.

The second approach is to forge better linkages and enhance collaboration between the criminal justice systems and the treatment clinics where effective medications for the treatment of alcohol and/or opioid dependence are available. The Criminal Justice-Drug Abuse Treatment Studies initiative of NIDA is currently funding a multi-city study. Its intent is to improve service coordination between parole and probation agencies and drug treatment clinics that provide medications for addiction treatment through an intervention aimed at improving knowledge and attitudes among community corrections (CC) staff and enhancing inter-organizational relationships. It is anticipated that improved knowledge and attitudes among CC staff will increase the number of criminal justice referrals to the treatment clinics.

Everyone wins by bringing the power of science to bear on the challenges of drug dependence in the criminal justice system. The opioid-dependent individuals reduce their likelihood of relapsing and dying of drug overdose upon release. A reduction in criminal and HIV-risk behavior improves public safety and protects the public health, and avoided episodes of reincarceration save the taxpayers money.

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19. October 2011 by stationmanager.

 Ice cream and other tasty, high-calorie foods would seem to have little in common with cocaine, but in some people’s brains they can elicit cravings and trigger responses similar to those caused by addictive drugs, a new study suggests.

Women whose relationship to food resembles dependence or addiction — those who often lose control and eat more than they’d planned, for example — appear to anticipate food in much the same way that drug addicts anticipate a fix, according to the study, which used functional magnetic resonance imaging (fMRI) brain scans.

When these women saw pictures of a chocolate milk shake made with Häagen-Dazs ice cream, they displayed increased activity in the same regions of the brain that fire when people who are dependent on drugs or alcohol experience cravings. When presented with the same milk shake, women who don’t feel addicted to food showed comparatively less activity in those regions.

Once the women actually tasted the milk shakes, however, those who scored high on a food-addiction scale showed dramatically less activity in the “reward circuitry” of their brains than the other women — phenomenon, also seen in substance dependence, that could lead to chronic overeating and other problematic eating behaviors, researchers say.

“It’s a one-two punch,” says the lead author of the study, Ashley Gearhardt, a Ph.D. candidate in psychology at Yale University. “First, you have a strong anticipation, but when you get what you are after, there’s less of an oomph than you expected, so you consume more in order to reach those expectations.”

The study, which appears in the Archives of General Psychiatry, included 48 young women with a wide range of body sizes who had signed up for a program aimed at helping them control their weight and develop better eating habits.

Each of the women filled out a 25-item questionnaire, adapted from assessments for drug and alcohol dependence, in which they were asked how strongly they agreed with statements such as “I find myself continuing to consume certain foods even though I am no longer hungry” and “When certain foods are not available, I will go out of my way to obtain them.” They were also asked to identify any foods — from a list including ice cream, chocolate, chips, pasta, cheeseburgers, and pizza — that gave them “problems.”

Then the researchers brought on the milk shakes, made with four scoops of Häagen-Dazs ice cream and Hershey’s chocolate syrup. While their brains were being scanned, the women were shown a picture of the milk shake to whet their appetite; five seconds later, they got to taste it. (As a comparison, each of the women was also shown a picture of a glass of water followed by a tasteless beverage.)

In addition to exhibiting patterns of craving and tolerance similar to those seen in drug addiction, the brains of women who scored high on the food-addiction scale showed less activity in areas responsible for self-control, which suggests that their brain chemistry may prime them to overindulge, Gearhardt says.

“It’s a combination of intense wanting coupled with disinhibition,” she says. “The ability to use willpower goes offline.”

The junk foods that are most likely to trigger cravings may be part of the problem. Over the past several decades, many foods have become less natural and more heavily refined, as sugars and fats have been added to make them tastier and more satisfying, says Gene-Jack Wang, M.D., a senior scientist at Brookhaven National Laboratory, in Upton, New York, who studies the brain’s role in obesity and eating disorders.

“Natural foods take a long time for the body to absorb,” says Wang, who was not involved in the study. “But the added sugars hit the brain right away.”

Some people, Wang adds, might be especially vulnerable to developing a dependence on such foods. “They may be genetically hardwired to like certain foods and to absorb them faster,” he says.

Over time, however, a person’s food of choice becomes less important as the cycle of dependence takes over, Gearhardt says. “At first you want it because it tastes good,” she explains. “But as you go from use to abuse to dependence, you begin to crave it and liking it doesn’t play as much of a role.”

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2. October 2011 by stationmanager.

It will come as no surprise to anyone reading this that we have a prescription drug problem in the United States. As I see it, however, we are not devoting our attention to the real root of the problem. Yes, we have prosecuted the drug-dealing doctors, pain clinics and pharmacies. Yes, we have taken on the middle-men (or women) between the doctors and the users. And yes, we have offered help to the addicts. But the real victims are their children, and they have gone overlooked.

I sentence pill peddlers every month. They tell me the same story in nearly every case: Good person gets hurt, gets prescribed pain killers, gets addicted, loses job, and starts dealing to sustain his habit. “A doctor prescribed it so it can’t be bad for you,” they thought. And more often than not, they have kids. Kids who lost their parents to drugs and will now lose them again to jail. With broken homes and terrible role models, they, too, are likely to turn to drugs.

Pills are the new drug of choice for kids. A recent survey revealed that young people 12 and older are abusing prescription drugs at greater rates than cocaine, heroin, hallucinogens, and methamphetamine combined.¹ Only marijuana abuse is more common.² And, most troubling, every day approximately 7,000 young people abuse a prescription narcotic for the first time.³

In turn, young adults are joining the ranks of prison inmates, state and federal. Recently, I sent two young women to the federal penitentiary—ages 22 and 23.

This is the new crack-cocaine epidemic, but worse. Not because it is both rural and urban—crack and other drugs have reached past the cities. Not because it is lethal—many drugs are lethal. It is worse because (1) doctors are the enablers (sometimes knowingly), (2) the supply seems to be endless, and (3) some of our youth falsely believe that prescription narcotics are a safe alternative to other illicit drugs.

And unlike other drugs which kids had to seek out, prescription drugs find them. In a recent survey, 55 percent of 12 to 17 year olds said they obtained prescription drugs from a relative or friend for free; 9 percent paid a friend or relative; and 5 percent took drugs from a friend or relative without asking.⁴ Less than 5 percent obtained the illicit drugs from a dealer, and approximately 18 percent obtained the prescription from a doctor.⁵

This problem is insidiously rampant, and law enforcement cannot handle it alone. Indeed, they can arguably only attack a small percentage of those providing our youth with drugs (the dealers and doctors). And while I think stiff sentences for those peddling drugs to our children can help, more action is needed to solve the problem.

Luckily, this is not a problem without a solution. First, every state should have a system like we have here in Kentucky that monitors every prescription. Budgets may be tight, but this is worth the cost. Second, we must educate our children. Studies have shown that talking to our children early and often deters them from using drugs. Third, we must educate adults about the problem: (1) they must act as role models; (2) be involved in their children’s lives, including paying attention to whom their children are spending time with; and (3) make sure they themselves are not the supplier by properly discarding old or unused prescriptions. Children with involved parents have a 50 percent lesser chance of trying and using drugs.⁶ Finally, we must educate doctors about the problem. While most doctors would not illegally prescribe pills, they should still be cognizant of the widespread abuse and exercise special care when prescribing these drugs. And, the few that ultimately choose to become dealers must be prosecuted and sentenced to very lengthy jail times.

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18. September 2011 by stationmanager.

Addiction is a chronic brain disorder and not simply a behavior problem involving alcohol, drugs, gambling or sex, experts contend in a new definition of addiction, one that is not solely related to problematic substance abuse.The American Society of Addiction Medicine (ASAM) just released this new definition of addiction after a four-year process involving more than 80 experts.

1. “At its core, addiction isn’t just a social problem or a moral problem or a criminal problem. It’s a brain problem whose behaviors manifest in all these other areas,” said Dr. Michael Miller, past president of ASAM who oversaw the development of the new definition. “Many behaviors driven by addiction are real problems and sometimes criminal acts. But the disease is about brains, not drugs. It’s about underlying neurology, not outward actions.”

The new definition also describes addiction as a primary disease, meaning that it’s not the result of other causes, such as emotional or psychiatric problems. And like cardiovascular disease and diabetes, addiction is recognized as a chronic disease; so it must be treated, managed and monitored over a person’s lifetime, the researchers say.

Two decades of advancements in neuroscience convinced ASAM officials that addiction should be redefined by what’s going on in the brain. For instance, research has shown that addiction affects the brain’s reward circuitry, such that memories of previous experiences with food, sex, alcohol and other drugs trigger cravings and more addictive behaviors. Brain circuitry that governs impulse control and judgment is also altered in the brains of addicts, resulting in the nonsensical pursuit of “rewards,” such as alcohol and other drugs.

A long-standing debate has roiled over whether addicts have a choice over their behaviors, said Dr. Raju Hajela, former president of the Canadian Society of Addiction Medicine and chair of the ASAM committee on addiction’s new definition.

“The disease creates distortions in thinking, feelings and perceptions, which drive people to behave in ways that are not understandable to others around them,” Hajela said in a statement. “Simply put, addiction is not a choice. Addictive behaviors are a manifestation of the disease, not a cause.”

n so, Hajela pointed out, choice does play a role in getting help.

“Because there is no pill which alone can cure addiction, choosing recovery over unhealthy behaviors is necessary,” Hajela said.

This “choosing recovery” is akin to people with heart disease who may not choose the underlying genetic causes of their heart problems but do need to choose to eat healthier or begin exercising, in addition to medical or surgical interventions, the researchers said.

“So, we have to stop moralizing, blaming, controlling or smirking at the person with the disease of addiction, and start creating opportunities for individuals and families to get help and providing assistance in choosing proper treatment,” Miller said.

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12. September 2011 by stationmanager.

Over the past year, SAMHSA – as part of its Recovery Support Strategic Initiative – has worked with the behavioral health field to develop a working definition of recovery that captures the essential, common experiences of those recovering from mental and substance use disorders, along with 10 guiding principles that support recovery.

One of the key events that led to the current working definition of recovery was a 2010 meeting of behavioral health leaders, including mental health consumers and people in addiction recovery, who developed a draft definition and principles of recovery to reflect common elements of the recovery experience for those with mental/substance use disorders. Other significant efforts include national consensus meetings that SAMHSA held in 2004 and 2005 to develop separate definitions of recovery from mental health problems and addictions. SAMHSA is developing a working definition of recovery to help policy makers, providers, funders, peers/consumers and others to design, deliver, and measure integrated and holistic services and supports to more effectively meet the needs of individuals served by behavioral health systems.

In recent months, SAMHSA has reviewed drafts of the working recovery definition and principles with stakeholders at meetings, conferences and other venues. Additionally, in May 2011, SAMHSA posted the working definition and principles on the SAMHSA blog and invited comments from the public. Many of the comments received have been incorporated into the current working definition and principles.

In order to encourage greater public engagement on this important definition, SAMHSA is inviting the public to provide further feedback.

The current working definition and principles are as follows:

Recovery from Mental and Substance Use Disorders: A process of change through which individuals work to improve their own health and wellbeing, live a self-directed life, and strive to achieve their full potential.

Through the Recovery Support Strategic Initiative, SAMHSA has delineated four major dimensions that are essential to a life in recovery:

• Health: overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way;
• Home: a stable and safe place to live;
• Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and
• Community: relationships and social networks that provide support, friendship, love, and hope.

Guiding Principles of Recovery

Recovery is person-driven: Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s) towards those goals. Individuals optimize their autonomy and independence to the greatest extent possible by leading, controlling, and exercising choice over the services and supports that assist their recovery and resilience. In so doing, they are empowered and provided the resources to make informed decisions, initiate recovery, build on their strengths, and gain or regain control over their lives. For children and youth, especially those who are younger, families and caregivers play a key and sometimes primary role in shaping their path to recovery.

Recovery occurs via many pathways: Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds  including trauma experiences  that affect and determine their pathway(s) to recovery. Recovery is built on the multiple capacities, strengths, talents, coping abilities, resources, and inherent value of each individual. Recovery pathways are highly personalized and non-linear in that they are characterized by continual growth and improved functioning that may involve setbacks. Because setbacks are a natural, though not inevitable, part of the recovery process, it is essential to foster resilience for all individuals and families. Abstinence is an important choice for individuals with addictions. In some cases, these pathways can be enabled by creating a supportive environment, this is especially true for children, who may not have the legal or developmental capacity to set their own course.

Recovery is holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. This includes addressing: self-care practices, family, housing, employment, education, addictions and mental illness treatment, services and supports, primary healthcare, dental care, complementary and alternative services, spirituality, creativity, social networks, recreation, and community participation. The array of services and supports available should be integrated and coordinated.

Recovery is supported by peers and allies: Mutual support and mutual aid groups, including the sharing of experiential knowledge and skills, as well as social learning, play an invaluable role in recovery. Peers encourage and engage other peers and provide each other with a vital sense of belonging, supportive relationships, valued roles, and community. Through helping others and giving back to the community, one helps one’s self. Peer-operated supports and services provide important resources to assist people along their journeys of recovery and wellness. Professionals can also play an important role in the recovery process by providing clinical treatment and other services that support individuals in their chosen recovery paths. While peers and allies play an important role for many in recovery, their role for children and youth may be slightly different. Peer supports for families are very important for children with behavioral health problems and can also play a supportive role for youth in recovery.

Recovery is supported through relationships and social networks: An important factor in the recovery process is the presence and involvement of people who believe in the person’s ability to recover; who offer hope, support, and encouragement; and who also suggest strategies and resources for change. Peers, family members, providers, faith groups, community members, and other allies form vital support networks. Through these relationships, people leave unhealthy and/or unfulfilling life roles behind and engage in new roles (e.g., partner, caregiver, friend, student, employee) that lead to a greater sense of belonging, personhood, empowerment, autonomy, social inclusion, and community participation.

Recovery is culturally-based and influenced: Culture and cultural background in all of its diverse representations – including values, traditions, and beliefs – are keys in determining a person’s journey and unique pathway to recovery. Services should be culturally grounded, attuned, sensitive, congruent, and competent, as well as personalized to meet each individual’s unique needs.

Recovery is supported by addressing trauma: The experience of trauma (such as physical or sexual abuse, domestic violence, war, disaster, and others) is often a precursor to or associated with alcohol and drug use, mental health problems, and related issues. Services and supports should be trauma-informed to foster safety (physical and emotional) and trust, as well as promote choice, empowerment, and collaboration.

Recovery involves individual, family, and community strengths and responsibility: Individuals, families, and communities have strengths and resources that serve as a foundation for recovery. In addition, individuals have a personal responsibility for their own self-care and journeys of recovery. Individuals should be supported in speaking for themselves. Families and significant others have responsibilities to support their loved ones, especially for children and youth in recovery. Communities have responsibilities to provide opportunities and resources to address discrimination and to foster social inclusion and recovery. Individuals in recovery also have a social responsibility and should have the ability to join with peers to speak collectively about their strengths, needs, wants, desires, and aspirations.

Recovery is based on respect: Community, systems, and societal acceptance and appreciation for people affected by mental health and substance use problems – including protecting their rights and eliminating discrimination – are crucial in achieving recovery. There is a need to acknowledge that taking steps towards recovery may require great courage. Self-acceptance, developing a positive and meaningful sense of identity, and regaining belief in one’s self are particularly important.

Recovery emerges from hope: The belief that recovery is real provides the essential and motivating message of a better future – that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them. Hope is internalized and can be fostered by peers, families, providers, allies, and others. Hope is the catalyst of the recovery process.

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