Laser lights to brain may help shut off addiction: Discoveries Print By Brie Zeltner, The Plain DealerThe Plain Dealer Follow on Twitter on May 13, 2013 at 5:00 PM, updated May 14, 2013 at 8:26 AM

Cocaine addiction, which affects about 1.4 million Americans, may soon be treated by stimulating an area of the brain that is "silenced" by the addiction. Associated Press file

CLEVELAND, Ohio-- There are occasional innovations that revolutionize a scientific field, offering answers to questions that had once been only theoretical.
Mapping the human genome was one such advance.
Optogenetics is another. The technique, which over the past eight years has galvanized brain research, has transformed neuroscientists from passive observers of the brain to active manipulators of its workings.
Amazingly, these researchers can now use hair-thin fiber-optic laser lights to turn individual brain cells on or off, and can watch as their animal subjects' behavior changes accordingly.
The most recent study to make use of the method in rats has immediate implications for the approximately 1.4 million Americans who are addicted to cocaine.
Researchers with the National Institutes of Health, the Ernest Gallo Clinic and the Research Center at the University of California, San Francisco, successfully used optogenetics to cure cocaine addiction in rats by stimulating the prefrontal cortex, a part of the brain that had been "silenced" by repeated exposure to the drug.
The health consequences of cocaine addiction are serious. Heavy use may double the brain's aging. Even occasional use of cocaine may boost the risk of heart problems, and the drug is also a leading cause of heart attacks and strokes for people under 35.

While researchers won't be implanting fiber optics into human brains anytime soon to short-circuit addiction, there is another safe, FDA-approved way to stimulate the same area in cocaine addicts, they say. It is transcranial magnetic stimulation, or TMS, which uses a portable, powerful electromagnet to deliver a magnetic pulse strong enough to evoke electrical activity in the brain. TMS has been used to treat depression.

“We don’t need to wait 10 or 15 years to possibly figure out what to give to patients as a therapy."

"We don't need to look for a drug," said the study's principal investigator, Dr. Antonello Bonci, scientific director of the intramural research program at the NIH's National Institute on Drug Abuse. Using an already-approved treatment such as TMS will shave years off the time it takes to get the potential treatment to patients.
"We don't need to wait 10 or 15 years to possibly figure out what to give to patients as a therapy -- we have the ability now to set up clinical trials and hopefully try to help patients within a matter of months."
Bonci and his team think they could have a TMS clinical trial for cocaine addicts recruiting patients by the end of the year.
Their confidence stems from the somewhat stunning black-and-white nature of their results in rats, which were unheard of before optogenetics. Their study, published in April in the journal Nature, explained how rats trained to seek cocaine rewards were cured by a switch in the prefrontal cortex.
To produce a group of rats that closely mimic human addiction, the researchers first gave the animals free access to cocaine, which they could get by pressing a lever. Then they introduced mild shocks to the rats' feet at random intervals as a negative consequence of the drug use.
About 70 percent of the rats stopped pressing the lever when the shocks started. The rest, though, kept compulsively seeking the cocaine reward despite the unpleasant result; they were addicted.
"The addicted rats showed this silence in that part of the brain," Bonci said, which the researchers were able to measure electrically after the animals were euthanized. The prefrontal cortex, the area "silenced" by the cocaine addiction, correlates to the dorsal anterior cingulate cortex in people, he said.
"Human studies have shown that chronic cocaine abusers do have a very low productivity in that area," Bonci said. Both brain areas appear to be implicated in regulating the conscious control of decisions that either harm or benefit: In this case, should I take the drug, or not?
The addicted rats' brain cells in this area were then turned into on/off switches using the optogenetics technique. Researchers injected special light-activated proteins (called rhodopsins) targeted to that brain area by genetic manipulation, and implanted the tiny fiber optic cables.
With the flip of a switch, laser light from the fiber-optic cable turned on activity in the prefrontal cortex, and "within a matter of hours" the addicted rats were no longer addicted.
Even more amazing, perhaps, is what the group did to further prove that they were targeting the right area. They took the nonaddicted rats (the ones that stopped going after the cocaine when shocked) and used their method to turn off the prefrontal cortex area. The rats became addicts just as quickly.
"This is amazing," Bonci said. "It shows causality, that the activity of this brain region is clearly tied to this behavior, but also that the brain can go back to normal after months of exposure to something that is pretty toxic."
"[TMS] is cruder, but of course the advantage is that it's not invasive and you have nearly zero side effects," he said. "What matters for now is that we know what we should be doing in that brain region to try to reduce craving. We know what to do and we have proof that it should work."
And that's very good news for the millions of people struggling with addiction and for those who love them, too.

The addict's stigma: Perception of weakness hampers treatment: Editorial

By Star-Ledger Editorial BoardThe Star-Ledger
on February 24, 2013 at 7:10 AM, updated February 25, 2013 at 11:54 AM

 

The first time a person sips a drink, takes a painkiller or shoots heroin, there'™s no addiction. Over time, however, the substance takes hold and dependency develops. Hardliners say it'™s weak willpower; medicine says addicts no longer have a choice.File photo

If you’re diabetic and binge on birthday cake, you can go to the emergency room for treatment — and health insurance will pay for it. You get the same medical care for your third heart attack that you did for the first two, again, with full coverage.
But the underlying attitude in the United States, clouded by social and legal stigma, is that addicts get one shot. Get clean, but fall off the wagon, and you’re on your own.
And, as The Star-Ledger’s Dan Goldberg reported in last Sunday’s editions, many families find convincing their health insurers to cover addiction treatment is a life-and-death struggle. Some commit fraud, lying their way into inpatient rehab programs.
Diseases afflicting the body — diabetes, heart disease, cancer — have clear paths for treatment, as recommended by your physician. Depending on your policy, doctors and insurers might quibble over details, but care is typically covered.
Addiction, on the other hand, is stigmatized as a personality weakness. Just as marijuana’s medicinal value was ignored because pot’s illegal, the perception of people addicted to drugs such as heroin is clouded by law, too.
The first time a person sips a drink, takes a painkiller or shoots heroin, there’s no addiction. Over time, however, the substance takes hold and dependency develops. Hardliners say it’s weak willpower; medicine says addicts no longer have a choice.

Insurers told The Star-Ledger cost-benefit calls are made on all medical treatments, including addiction. They might cover less expensive outpatient rehab, even when doctors recommend costlier inpatient stays. In that respect, critics say, addiction is treated differently, and parity laws are needed to ensure addiction has equal access to care.

If a diabetic misses an insulin shot, doctors restore the blood-sugar balance. If an addict slips, we call it relapse and say treatment didn't work.

The Affordable Care Act requires addiction and mental health parity, but it’s still part of the law’s interim rules, and advocates worry there’s too much wiggle room for insurers to deny coverage.
In New Jersey, where heroin addiction is rising at double-digit rates, parity laws have failed to advance in past legislative sessions, though a bill mandating parity in state employee health plans is moving through the Legislature.
Like diabetes, addiction is chronic, forcing patients to make lifestyle changes. When a diabetic misses an insulin shot, doctors try to restore the blood-sugar balance. When an addict slips, we call it a “relapse” and say treatment didn’t work. Both patients need — and deserve — lifetime care to maintain balance.
The “addicts brought this on themselves” argument can be made about overeaters who get diabetes or smokers who get lung cancer. Addictions deserve the same access to insurance coverage. It’s the right path, medically and morally.

Intervention for High-Risk Teens Can Reduce Alcohol Abuse

By Rick Nauert PhDSenior News Editor
Reviewed by John M. Grohol, Psy.D. on January 25, 2013

Mental health interventions directed toward high-risk teenagers significantly reduces their drinking behavior and that of their schoolmates.

Results from the randomized study were so strong that UK researchers believe the intervention should be administered throughout the country to help prevent teenage alcohol abuse.
The study is published in JAMA Psychiatry.

The research effort, termed the “Adventure Trial,” involved 21 schools in London that were randomly allocated to either receive the intervention, or the UK statutory drug and alcohol education curriculum.

A total of 2,548 year-10 students (average age 13.8 years) were classed as high or low-risk of developing future alcohol dependency. Those classed as high-risk fit one of four personality risk profiles: anxiety, hopelessness, impulsivity or sensation-seeking.

Eleven students were monitored for their drinking behavior over two years. Four members of staff in each intervention school were trained to deliver group workshops targeting the different personality profiles. Eleven schools also received the intervention where 709 high-risk teenagers were invited to attend two workshops that guided them in learning cognitive-behavioral strategies for coping with their particular personality profiles.

Clinical psychologist Dr. Patricia Conrod, from King’s Institute of Psychiatry and lead author of the paper, said: “Through the workshops, the teenagers learn to better manage their personality traits and individual tendencies, helping them to make good decisions for themselves.
Researchers discovered cognitive-behavioral strategies helped some students better manage high levels of anxiety, reduce their tendency to have pessimistic reactions to certain situations, and helped to control their tendency to react impulsively or aggressively.

“Our study shows that this mental health approach to alcohol prevention is much more successful in reducing drinking behavior than giving teenagers general information on the dangers of alcohol.”
After two years, high-risk students in intervention schools were at a 29 percent reduced risk of drinking, 43 percent reduced risk of binge drinking and 29 percent reduced risk of problem drinking compared to high-risk students in control schools.

The intervention also significantly delayed the natural progression to more risky drinking behavior (such as frequent binge drinking, greater quantity of drinking, and severity of problem drinking) in the high-risk students over the two years.

Additionally, over the two year period, low-risk teenagers in the intervention schools, who did not receive the intervention, were at a 29 percent reduced risk of taking up drinking and 35 percent reduced risk of binge drinking compared to the low-risk group in the non-intervention schools, indicating a possible ‘herd effect’ in this population.

An excellent upside of the intervention is the carry-over effect reducing unhealthy behavior among friends and peers of the youth receiving the intensive counseling.

“This ‘herd effect’ is very important from a public health perspective as it suggests that the benefits of mental health interventions on drinking behaviour also extend to the general population, possibly by reducing the number of drinking occasions young people are exposed to in early adolescence.”
Said Conrod, “This intervention could be widely administered to schools: it is successful from a public health perspective, appreciated by students and staff, and because we train school staff rather than professional psychologists, the intervention remains relatively inexpensive to roll-out.”
Drinking is a significant issue in England as approximately 6 out of 10 people aged 11-15 in England drink and approximately 5,000 teenagers are admitted to hospital every year for alcohol related reasons.

Across the developed world, alcohol accounts for approximately 9 percent of all deaths of people aged 15-29, and so far, universal community or school-based interventions have proven difficult to implement and shown limited success.

Nick Barton, chief executive of Action on Addiction, said: “Dr. Conrod’s study, which helps young people reduce their chances of developing an addiction to alcohol and/or drugs in the future, is an exciting development for prevention work in the UK.

“This is generally recognized as inadequate, and as we see regularly in the media, currently fails to address binge drinking and drug taking among young people. We treat a large number of people who began misusing substances in their school years, and we welcome any evidence-based research which may help to reverse this trend.”

Source: King’s College London

World's first alcoholism vaccine to run preclinical trial in Chile

World’s first alcoholism vaccine to run preclinical trial in Chile

Tuesday, 22 January 2013 19:57

Written by Katie Manning  

Vaccine promises to cure alcoholism, but without mental health treatment, could society swap one addiction for another?

Splitting headaches and waves of nausea – a drinker’s worst enemy – may soon provide alcoholics with an unlikely rescue from a crippling addiction. A preclinical trial for the Universidad de Chile’s alcoholism vaccine, set to break ground in February, will use mice to determine dosing. Researchers will apply the findings to a human trial in November this year.

Dr. Juan Asenjo, director of the Institute for Cell Dynamics and Biotechnology at Universidad de Chile, thinks that although the vaccine is not a cure-all, it could provide an important first step.

“People who end up alcoholic have a social problem; a personality problem because they’re shy, whatever, and then they are depressed, so it’s not so simple,” Asenjo said. “But if we can solve the chemical, the basic part of the problem, I think it could help quite a bit.”

The preclinical trial precludes the phase one clinical trial in India, when doctors will inject people with the vaccine for the first time. If all goes well, the vaccination could be available as soon as two years from now, according to Asenjo.

The vaccine could affect hundreds of millions of alcoholics worldwide. In Chile, one in 15 men have an alcohol use disorder, according to the most recent 2011 study from the World Health Organization (WHO).

“If it works, it’s going to have a worldwide impact, but with many vaccines one has to test them carefully. I think the chances that this one will work are quite high,” said Asenjo.

Normally, the liver turns alcohol into the compound acetaldehyde, which can be thanked for the vicious hangovers that often follow heavy drinking. An alcohol-metabolizing enzyme then breaks the compound down.

The vaccine would work for six months to one year through RNA, which can control gene expression. The so-called anti-aldh2 antisense RNA acts as a messenger to tell the liver not to express genes that metabolize alcohol. In other words, the vaccine ups the ante on hangovers in order to discourage consumption.

Asenjo said his research team in Chile is heading up the only trial of alcohol vaccines in the world, but the concept isn’t new.

Nearly a century ago, a drug called Disul?ram hit the shelves. Disulfiram blocks the enzyme from breaking down alcohol, thus intensifying the body’s negative response to alcohol.

The drug doesn’t ease intense cravings and has a high toxicity level. Coping with harsher hangovers is apparently a tough pill to swallow as patients often don’t continue taking the medicine as directed.

The vaccine, once injected, can’t be reversed until completion.

Inspiration for the vaccine struck from the far East, said Asenjo. Some hangover-prone individuals have a gene mutation that, like Disulfiram, inhibits the breakdown of alcohol and subsequently slashes alcoholism rates among those with the gene.

“People who are Japanese, Chinese or Korean and have this mutation – Let’s say 15 to 20 percent of the population – they don’t touch alcohol, and that’s because they feel bad with the vomit and the nausea,” Asenjo said.

Chile’s National Commission for Scientific and Technological Research’s (CONICYT) Fondef program, which gives money to develop science and technology, financed researchers at Universidad de Chile to look into this phenomenon. They found a way to alter a person’s gene expression to mimic this gene mutation, thus providing a long-term treatment.

The only lasting treatment currently available demands an iron will, according to the director of general services at Alcoholics Anonymous (AA) Chile. He said hasn’t picked up a drink in the past 36 of his 75 years.

The recovering alcoholic, who asked to remain anonymous, agreed that a vaccine alone can’t solve addiction.

“Personally, I hope it works, but it’s not so easy for the person who already has alcoholism,” said the director. “Once you have this problem. You don’t have a solution. You pick up a drink, think you can handle a few, but it’s not possible.”

He leafed through a long list of AA’s sister organizations from Neurotics Anonymous, Smokers Anonymous to Compulsive Shoppers Anonymous. A vaccine, he said, can’t cure all. It won’t fix the mental challenges that plague addicts. They might latch onto an even more lethal substance with alcohol out of the picture.

“I had a friend. He quit drinking. Then he became a terrible smoker. He was connected to an oxygen tank for two months to keep him alive,” said the director.

“A person needs to confront themselves,” he added.

By Katie Manning (manning@santiagotimes.cl)Copyright 2013 - The Santiago Times

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As Florida Bath Salts death rise, drug enforcers, stymied

Bath salts are synthetic drugs that can be snorted with effects similar to ecstasy or cocaine. But bath salts are easier to obtain — online or at head shops and convenience stores — and cheaper.

AS FLORIDA BATH SALTS DEATH RISES, DRUG ENFORCERS, STYMIED
By Jessica Vander Velde, Times Staff Writer
Jessica Vander VeldeTampa Bay Times In Print: Sunday, October 14, 2012

Story Tools Print this story Purchase reprints Contact the editor Email Newsletters Jairious McGhee, 23, was a caterer with no criminal record when he died after using bath salts in Tampa in April 2011. Related Links Snapshots: The faces of bath salts deaths in Florida Designer drugs slip past prosecution

TAMPA — When Jairious McGhee ran through a busy Tampa intersection screaming rap lyrics, when an officer's Taser barely slowed him and he fought off medics, when his heart stopped five times and he eventually died, the drug in his body was legal in most states.

It was April 2011, and bath salts had made few headlines. Attorney General Pam Bondi had just issued a temporary ban on the drug in Florida, but within three months, the U.S. Department of Justice would be calling this fine white powder an "emerging domestic threat."

Now its use is spreading, as law enforcement struggles to deal with a new designer drug that changes shape every time officials try to crack down.

More than 20 people have died in Florida from bath salts, according to a Tampa Bay Times examination of the drug's impact in Florida.

Two of the victims — both 23-year-old men — died in Tampa. One thought he was using ecstasy at a rave. The other was a caterer with no criminal record.
Both had methylone in their system, a type of "bath salts," which is the street name for this stimulant meant to mimic ecstasy or cocaine.

Methylone is now illegal in the United States, added by federal authorities to a list of banned chemicals that grows each year. But many variations are still being openly sold because every time legislators outlaw one compound, chemists simply tweak the formula to produce an unregulated drug.

Meanwhile, Florida medical examiner reports show bath salts are killing people across race, age and gender divisions.

Some die horrible deaths, like the Tampa caterer, Jairious McGhee — the first known bath salts death in the Tampa Bay area. His temperature skyrocketed, causing his muscles to break down and release toxins.

Others simply do not wake up.

And more still are committing shocking acts after using bath salts. According to their own accounts:
A California man attacked an elderly woman with a shovel.

A Pennsylvania man kicked a trooper and bit a paramedic.

A Georgia man went wild at a golf course and threatened to eat people.
Perhaps a Miami man actually did.

Authorities initially suspected bath salts when Rudy Eugene chewed off most of a homeless man's face in May. Tests confirmed the presence of marijuana, but scientists say it is possible Eugene had another drug in his system. Most toxicology labs do not have the ability to test for the newest synthetic drugs.

This summer, the U.S. Drug Enforcement Administration announced a national synthetic drug roundup — the first of its kind — called "Operation Log Jam." But unless laws are strengthened, legislators will have to ban a virtually limitless list of stimulants or face lengthy, expensive legal battles. At street level, police don't seem to have a strategy, focusing instead on traditional illegal drugs and prescription drug abuse.

Meanwhile, more people are being rushed to emergency rooms, and scientists can only guess bath salts' long-term effects.

"Who's to say that the ingestion of these drugs won't result in neurologic problems?" said University of Florida toxicology director Bruce Goldberger. "There are no studies at all."
• • •

Julia Pearson studied the drug screen results on her computer. A telltale peak in the mass spectrum told her that Jairious McGhee had a stimulant in his system when he died.
But what kind?

Pearson, the chief forensic toxicologist at the Hillsborough Medical Examiner's Office, thought the results looked similar to a case of bath salts discussed in the previous month's ToxTalk newsletter. But no one had published methods for confirming all the emerging types of this drug.

In early 2011, Pearson and the rest of the country did not know much about bath salts.

The previous year, Poison Control centers nationwide received only 304 calls about bath salts.
By the end of 2011, the number of calls would grow 20 times to more than 6,000.

Despite its name, this drug has nothing to do with relaxing crystals for the tub.

Instead, "bath salts" is the umbrella term for synthetic cathinones, a substance found naturally in a shrub called khat (pronounced "cot"). The plant has been abused and banned in the United States for decades and is native to east Africa and southern Arabia, where it is legal. Much of Yemen's agriculture is devoted to the plant.

Cathinones are similar to amphetamines, which include the popular drug methamphetamine (meth). And they are in the same drug class as ecstasy.

Their misuse is not new. One chemical variation — methcathinone — was used as an antidepressant in the Soviet Union in the 1930s and misused as a recreational drug in the 1970s and '80s.
So why the resurgence?

Some believe it is because bath salts have effects similar to ecstasy and cocaine, which are hard to get in their pure forms now. Bath salts are easy to obtain — available online or at head shops and convenience stores.

They are also cheap, selling for about $25 for a small packet. And they do not show up on common drug tests.

Despite some of the side effects, including increased heart rate and temperature, bath salts can sometimes feel exciting or empowering, users and scientists say. The drug promotes the release of the feel-good neurotransmitters dopamine, serotonin and norepinephrine.

Jessica Gillespie remembers the euphoria.

One particular strain — which came in a packet with a picture of a smiling snowman — was like pure cocaine without the cravings or comedown, she recalled.

Gillespie, a 28-year-old hairdresser from Arizona, spent a month at a Florida drug rehabilitation center this summer after she was intervened upon by Kevin Dixon, Interventionist, President and Founder of KD Consulting.org because, she says, she was addicted to bath salts.

Scientific studies have not confirmed that addiction is possible, but Gillespie says she felt compelled to use the drug even though it drove her to scratch at her feet until they bled.

It drove her apart from her husband and made her heart beat so rapidly, she would lie in bed and pray she would live through the night.

"I'll never do this again," she remembers pleading. "Please let me wake up in the morning."
• • •
A teenage boy convulsed on the ground at a St. Petersburg hospital, yelling garbled religious phrases — something about being a god.

Though he was only about 120 pounds, it took several people to restrain him at Bayfront Medical Center. Workers strapped him to a hospital bed and injected sedatives into his veins. Then they put him on a ventilator.

Dr. Hiten Upadhyay assumed the boy had ingested something. He had arrived at the hospital with another teen who had similar symptoms.

The young men's friend told the doctor: bath salts.

This was a year ago, and the doctor had never heard of bath salts. He typed the phrase into a search engine. Then he called Poison Control.

At Tampa General, Dr. Jacob Eastman believes he has seen about 10 cases of bath salts intoxication over the past year, but he cannot be sure. No quick test exists, so doctors and police are often left wondering.

Emergency room physicians have to rely on anecdotal information. Then, because there isn't a cure, doctors simply provide supportive care. If patients' temperatures are high, doctors give them chilled blankets and cool intravenous fluids. If they are agitated, they get sedatives.

Upadhyay says when the teenage boy he treated a year ago woke up the next day, he did not remember what happened.

Scientists do not know why some people survive and others, like Jairious McGhee, die. It could be the quantity or the type of cathinone used. Maybe it was the person's body type or metabolism. Other drug and alcohol use could play a role.

Sherri Kacinko is a toxicologist with NMS Labs — a Pennsylvania company that develops tests for new drugs — and though she studies bath salts, even she is not sure of all the drug's effects.
In presentations to scientists across the country, she often jokes that users should contact her for the sake of science:

"Please call me so I can get blood and urine samples," she says.
• • •
In December 2011, a 23-year-old St. Petersburg man was raving at an East Tampa after-hours club called Rat Soap, where dancers wave glow sticks to thumping electronic music.
At some point he used the same type of bath salts McGhee did — methylone. But records indicate Nelson Martinez thought he was using ecstasy.

Soon, clubgoers noticed Martinez "freaking out."

According to a court document filed by Tampa police, the club's manager sat Martinez down in a chair, wrapped him in plastic wrap to stop his flailing and forced a Valium in his mouth. With the help of another, the manager loaded Martinez in a van.

When Martinez's friends got a call about him, they headed to the club and found Martinez still in the van.
He was having a seizure and foaming at the mouth. His temperature was 107.
An hour later, he was dead.
• • •
A year ago, a high-ranking official with the U.S. Drug Enforcement Administration testified in front of Congress about a "new era of drug distribution."

"No longer are these substances sold in a covert manner to thwart law enforcement efforts," said Deputy Assistant Administrator Joseph Rannazzisi.

With this strategy, designer drugmakers are winning.

While Tampa Bay area law enforcement is targeting synthetic marijuana, bath salts are slipping by them.

A couple of issues are at play: Officers often do not know what they're seeing. Also, bath salts are not prescribed by doctors or dealt on the streets.

Finally, with prescription drug abuse at the epidemic level, synthetics are not always a priority — unless an agency makes it one.

Attorney General Bondi has said cracking down on synthetic drugs is of great concern, but the state's lawmakers have been bogged down by a "cat-and-mouse game."

Bondi calls the drugmakers "creative chemists" and said the manufacturers — largely based in labs in China, Pakistan and India — rebound quickly. Federal officials believe the drugs are made in large quantities, then shipped to Europe for distribution.

"It's a moneymaking business," she said.

In a recent study, Indiana toxicologists confirmed that drugmakers indeed are staying ahead of the law. Soon after the first major federal ban was announced Sept. 7, 2011, packages released into market had new chemicals.

Similar, but legal.
The Times recently purchased bath salts from an online company that promised its products were legal in Florida. The company required a direct deposit into a British bank, and the packets arrived in an envelope sent from Spain.

Each packet cost about $30.

The drug? According to a chemical analysis paid for by the Times, it was methiopropamine.
This compound is similar to the widespread — and outlawed — methamphetamine (or meth).
And it is legal in Florida.

Legal, unless authorities use a federal law called the Analog Act to assert that this compound is "substantially similar" to meth.

But the Analog Act, passed in 1986, is riddled with problems because it is vague. Prosecutors rarely use it.

In an online drug forum, "Synthetic Dave" provided his take on the country's war on bath salts:
Congress is retarded, like all of the chemists and vendors and even users say: "You keep banning them, Well keep making new ones" … I laugh when i see this because they are never going to win.
Authorities agree that, for now, they are not going to win.

"Just trying to ban as many chemicals as possible is not going to solve this problem," said DEA spokesman Rusty Payne.

Authorities say they need another tool because, in the words of Hillsborough chief toxicologist Pearson, these chemists are "relentless."

"It's a never-ending revolving door."
Times news researchers John Martin and Natalie Watson contributed to this report, which used information from the Associated Press. Jessica Vander Velde can be reached at jvandervelde@tampabay.com

Common effects of bath salts
• accelerated heartbeat
• agitation
• anxiety
• hyperthermia
• hallucinations
• confusion
• nausea
• chest pain
• breathlessness
• insomnia
Source: Advisory Council on the Misuse of Drugs

Recognizing the alcoholic patient

Patients who struggle with alcohol can be difficult to spot. Better training, starting as early as medical school, can ensure these patients get needed treatment.

By Carolyne Krupa, amednews staff. Posted Oct. 15, 2012.

 

Some are easier to spot than others.

It may be as obvious as encountering an intoxicated patient in the emergency room. Or as subtle as noting a hypertensive patient who seems otherwise healthy but has mysteriously missed his or her last few appointments.

Alcoholism presents itself through a variety of signs, symptoms and severities, said Jeffrey Samet, MD, MPH, chief of general internal medicine at Boston Medical Center, professor of medicine at Boston University School of Medicine and professor of community health sciences at Boston University School of Public Health. He is president of the American Board of Addiction Medicine.

“They come in a whole spectrum of obviousness,” he said. “It’s not necessarily going to hit you over the head. It can be highly, highly challenging.”

Primary care physicians can feel ill-equipped to identify and care for such patients, but they play a crucial role in ensuring that individuals get treatment, said Raye Litten, PhD, associate director of the National Institute on Alcohol Abuse and Alcoholism’s Division of Treatment and Recovery Research. Most people who have problems with alcohol use don’t seek care from a specialist.

Most doctors are not sufficiently trained to identify or diagnose substance abuse.

 

“Usually, the primary care physician may be the only medical professional that people with alcohol problems will see, and maybe not for the alcohol, but for whatever other problems it is causing,” Litten said.

For that reason, it’s important that primary care physicians be able to identify those patients and get involved to help ensure they are treated to control their drinking, he said.

“In many cases, if the doctor doesn’t get involved, the patient dies,” said Nicholas Pace, MD, clinical associate professor at New York University Langone Medical Center.

A June report by the National Center on Addiction and Substance Abuse at Columbia University in New York found that most health professionals are not sufficiently trained to identify or diagnose substance abuse. They often are unfamiliar with the signs and symptoms of addiction, and they don’t know the best treatment options for patients. As a result, many of those who do provide treatment for addiction are not medical professionals and lack the knowledge and skills to provide the full range of available evidence-based treatments, the report said.

About one in seven Americans 12 and older (40.3 million people) meets the clinical criteria for substance abuse addiction. Seven percent of Americans have an addiction involving alcohol, either to alcohol alone or to alcohol and one or more other substances, said Susan E. Foster, vice president and director of the Columbia center’s Division of Policy Research and Analysis and principal investigator on the report. The high prevalence of the disease makes it something that primary care physicians encounter on a regular basis, she said.

“You can’t practice primary care without seeing patients with current or past alcohol problems every day,” said Patrick G. O’Connor, MD, MPH, professor of medicine and chief of general internal medicine at Yale School of Medicine in Connecticut.

Beyond full-blown alcoholism, many more people are involved in risky levels of drinking. The National Institute on Alcohol Abuse and Alcoholism defines risky drinking as more than four drinks on any single day and no more than 14 drinks per week for men. For women, such drinking means no more than three drinks on any single day and no more than seven drinks per week. An estimated 18 million Americans have an alcohol use disorder and 40 million are high-risk drinkers, Litten said.

Obstacles to care

Primary care physicians face several challenges in identifying patients who have problems with alcohol. Many patients may not be comfortable talking with doctors about drinking, and doctors have a limited time to meet with each patient, Dr. Samet said.

“With primary care, if you’re seeing a patient in a usual clinic, there are so many issues on the table that this one may be lost in the shuffle,” he said.

18 million Americans have an alcohol-use disorder.

 

Depending on their training, physicians may not recognize that a patient is addicted to alcohol, Dr. O’Connor said. Historically, medical schools have not provided much training on treating people with alcohol problems, and that lack of training often continues into graduate medical education training, he said.

One issue is that medical schools have a lot of competing subjects to cover in four years. Even so, educating students about alcoholism should be a priority, Dr. O’Connor said.

“There are knowledge barriers in how to identify them, as well as what to do with them when you have them,” he said. “Given that alcohol use disorders are so common in medical populations, it’s ridiculous to think that it’s ignored as much as it is.”

In caring for these patients, there are other barriers, such as the availability of services, the patients’ willingness to undergo treatment and insurance coverage for addiction services, O’Connor said.
Then there is the question of the doctor’s attitude. Despite research proving that alcohol addiction is a disease with serious physiological consequences, some physicians still blame the patient, said Dennis H. Novack, MD, professor of medicine and associate dean of medical education at Drexel University College of Medicine in Philadelphia.

“There is a lot of misunderstanding and bias, even among physicians,” Dr. Novack said. “Until physicians see alcoholism as a chronic disease for which there is no cure, you can’t help the patient.”
Instituting some type of standardized screening process can make a difference, Dr. Pace said. The Alcohol Use Disorders Identification Test can help physicians identify patients with alcohol issues. It involves asking patients questions about how much they drink, what they drink and when they drink.

40 million Americans are high-risk drinkers.

 

“Alcoholism is the big masquerader,” Dr. Pace said. “If the patient has several issues and a physician can’t figure out what’s really wrong, they should really think about alcohol and alcoholism. You have to keep in mind that you see the whole spectrum of the disease. It comes in all sizes, shapes and colors and really mimics so many other problems.”

Patients struggling with alcohol use may display a variety of symptoms, including indigestion, hypertension and liver problems, Dr. O’Connor said. Physicians should routinely screen patients for alcohol use, he said.

In talking with patients, physicians should make it clear that their discussions are confidential, Dr. O’Connor said. They also should discuss what could happen if the patient pursues treatment. Alcohol counseling can be brief, similar to discussions on other health issues such as diabetes and hypertension.

“If you don’t address those issues, they will make other medical issues worse,” Dr. O’Connor said.
Excessive alcohol use raises blood pressure and can contribute to a litany of medical problems, Dr. O’Connor said. Hypertension can lead to cardiac arrhythmia; problems with the gastrointestinal system, liver and pancreas; and neurological problems such as dementia.

The NIAAA provides resources for physicians and the public. Its guide for doctors recommends asking patients how many times in the past year they have had more than five drinks at a time. Asking that single question can help physicians identify up to 82% of people who have alcohol problems, Litten said.

It’s important that physicians not be reproachful or judgmental of patients, but express concern for their health and welfare, said David Bronson, MD, a general internist and president of the American College of Physicians. If doctors immediately ask a patient about drinking, the patient may feel attacked. It’s important to frame the question as a series of other general health questions that the doctor would ask of all patients.

“You have to make them feel comfortable about it,” Dr. Bronson said. “It should be a routine for all of your patients.”

Educating young doctors about alcohol

Some medical schools are working to make sure students are exposed to the issues of alcohol addiction early in their training. For example, first-year students at Drexel University College of Medicine are required to attend an Alcoholics Anonymous meeting. Two AA members also come to the school to talk with students about their experiences in small group sessions.

“We want our students to understand and see AA as a resource, but we also want our students to understand what people with this disease are going through,” Dr. Novack said. “They have gone through hell and back, and they have a lot that they can share that I think can help break some of the biases of our students.”

At the GME level, Dr. Pace has been leading a course for first-year internal medicine residents on alcoholism and substance abuse for about 10 years. The four-day course is offered once a month to residents at four New York hospitals.

As part of the course, AA members meet one on one with residents. They tell their stories, and residents present those to the class at the end of the course. Students also attend an AA meeting and work with trained actors to practice interviewing patients about their alcohol use. They also meet a physician who has struggled with substance abuse addiction, and they hear how it affected careers and personal lives, Dr. Pace said.

All internal medicine residents at Lenox Hill Hospital are required to take the course, said Robin Dibner, MD, director of the hospital’s internal medicine residency program and clinical associate professor at NYU School of Medicine.

“I just felt that there was nowhere in medical school that they were learning about this,” she said. “I think it should be a major part of curriculum for all residencies.”

Nicole Lapinel, MD, chief medical resident at Lenox Hill, said the program was eye-opening. Being able to talk one on one with an AA member and hear stories made a strong impression.

“You got to know this individual — when they first recognized that they had a problem and how they went about seeking treatment,” Dr. Lapinel said. “Sitting there listening to their very personal stories — as a physician you don’t normally get that perspective.”

The American Board of Addiction Medicine also is working to fill gaps in expertise about alcohol and substance abuse addictions. In 2011, the board launched its first residency programs in addiction medicine. There now are 10 programs around the country, Dr. Samet said.

Specialized training will help ensure that more patients who need help can get treatment, Dr. O’Connor said. “There is a huge dearth of specially trained physicians in this area.”

Weblink

National Institute on Alcohol Abuse and Alcoholism (www.niaaa.nih.gov/)
American Board of Addiction Medicine (www.abam.net/)
Alcoholics Anonymous (www.aa.org/)

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“Helping Patients Who Drink Too Much: A Clinician’s Guide,” National Institute on Alcohol Abuse and Alcoholism, Updated 2005 Edition (pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf)

Correction

This article originally incorrectly stated the title of Jeffrey Samet, MD, MPH. He is chief of general internal medicine at Boston Medical Center, professor of medicine at Boston University School of Medicine and professor of community health sciences at Boston University School of Public Health. In addition, the article gave an incorrect percentage of Americans who have an addiction involving alcohol. Seven percent have an addiction involving alcohol. American Medical News regrets the error.

Alcoholism Affects Men’s and Women’s Brains Differently

By Janice WoodAssociate News Editor
Reviewed by John M. Grohol, Psy.D. on August 11, 2012

New research has demonstrated that the effects on white matter brain volume from long-term alcohol abuse are different for men and women.

Researchers from Boston University School of Medicine (BUSM) and Veterans Affairs (VA) Boston Healthcare System also suggest that when they stop drinking, women recover their white matter brain volume more quickly than men.

Previous research has linked alcoholism with white matter reduction, according to the researchers, who explain that white matter forms the connections between neurons, allowing communication between different areas of the brain.

In this latest study, a research team, led by Susan Mosher Ruiz, Ph.D., a postdoctoral research scientist in the Laboratory for Neuropsychology at BUSM and research scientist at the VA Boston Healthcare System, and Marlene Oscar Berman, Ph.D., professor of psychiatry, neurology and anatomy and neurobiology at BUSM and research career scientist at the VA Boston Healthcare System, employed structural magnetic resonance imaging (MRI) to determine the effects of drinking history and gender on white matter volume.

They examined brain images from 42 abstinent alcoholic men and women who drank heavily for more than five years and 42 nonalcoholic men and women. The researchers found that a greater number of years of alcohol abuse was associated with smaller white matter volumes in the alcoholic men and women. In the men, the decrease was observed in the corpus callosum, while in women this effect was observed in cortical white matter regions.

“We believe that many of the cognitive and emotional deficits observed in people with chronic alcoholism, including memory problems and flat affect, are related to disconnections that result from a loss of white matter,” said Mosher Ruiz.

The researchers also found that the number of daily drinks had a strong impact on alcoholic women, with the volume loss 1.5 to 2 percent for each additional drink. Additionally, there was an 8 to 10 percent increase in the size of the brain ventricles, which are areas filled with cerebrospinal fluid (CSF) that play a protective role in the brain. When white matter dies, CSF produced in the ventricles fills the ventricular space.

The researchers also found that in men, white matter brain volume in the corpus callosum recovered at a rate of 1 percent per year for each year of abstinence. For people who abstained less than a year, the researchers found evidence of increased white matter volume and decreased ventricular volume in women, but not in men. However, for people in recovery for more than a year, those signs of recovery disappeared in women and became apparent in men.

“These findings preliminarily suggest that restoration and recovery of the brain’s white matter among alcoholics occurs later in abstinence for men than for women,” said Mosher Ruiz. “We hope that additional research in this area can help lead to improved treatment methods that include educating both alcoholic men and women about the harmful effects of excessive drinking and the potential for recovery with sustained abstinence.”

The research was published online in Alcoholism: Clinical and Experimental Research.
Source: Boston University Medical Center



APA ReferenceWood, J. (2012). Alcoholism Affects Men’s and Women’s Brains Differently. Psych Central. Retrieved on August 22, 2012, from http://psychcentral.com/news/2012/08/11/alcoholism-affects-mens-and-womens-brains-differently/42963.html