Gene mutation in worms could further understanding of alcoholism in humans

Scientists at the University of Liverpool have found that a genetic mutation in worms could further understanding of alcoholism in humans.

The work follows a study carried out by Oregon Health and Science University, which suggested a link between a gene mutation in mice and tolerance to alcohol. Researchers at Liverpool have investigated this in worms, looking specifically at the role the gene plays in communication between cells in the nervous system.

This gene specifies the ways in which amino acids arrange themselves into a protein called UNC-18 - or Munc18-1 in humans, an essential component of the nervous system. Researchers found that a naturally occurring change in this gene can result in a change in the nature of one of the amino acids, which then alters communication between cells in the nervous system. As a result of these changes the nervous system becomes less sensitive to the effects of alcohol, allowing the body to consume more.

Professor Bob Burgoyne, Head of the University's School of Biomedical Sciences, explains: "Alcohol consumption can affect the nervous system in a number of ways. Low concentrations of alcohol can make the body more alert, but high concentrations can also reduce its activity, resulting in motor dysfunction and a lack of coordination. Some people, however, are more susceptible to these effects than others, but it has never been fully understood why this is.

"We used the nematode worm as a model to look at the role genes play in alcohol tolerance because all of the worm's genome has been characterised and we can therefore identify its genes easily. The gene we looked at corresponds to a gene in humans that performs the same function in the nervous system. Mutations in genes can occur naturally without any known cause and will persist if they are not particularly harmful."

Dr Jeff Barclay, co-author of the research, added: "We investigated alterations in amino acids in two genetically identical worms. One carried a mutation that was exactly the same as the genetic change our American colleagues found in mice and the other carried a different change within the same gene. Both these mutations altered the way communicate occurs between cells in the nervous system. The mutations reduce the negative behavioural effects of alcohol and so more can be consumed before the body starts to react badly to it.

"Now that we have shown the link between the gene and alcohol tolerance in worms, it is possible to search the human gene to see if there are any spontaneous changes that could help identify individuals with a predisposition to alcoholism."

The research is published in Molecular Biology of the Cell.
____________________
source: http://www.news-medical.net

Study finds mom's beliefs may impact their kids' alcohol use

Mothers, take note. If you really want to curb your teens' chances of using alcohol, help them develop a self-view that doesn't include drinking. According to a new Iowa State University study, the power of positive thinking by moms may limit their children's alcohol use. But beware. The opposite is also true.

"When mothers overestimated their teens' future use of alcohol, the teens developed the self-view that they were likely to drink alcohol in the future, which ultimately led them to drink more," said Stephanie Madon, an ISU associate professor of psychology and lead author of the study.

Madon collaborated on the study with ISU graduate students Ashley Buller, Kyle Scherr and Jennifer Willard; Max Guyll, an assistant professor of psychology; and Richard Spoth, director of the Partnerships in Prevention Science Institute at Iowa State. They analyzed data obtained from a series of interviews with nearly 800 Iowa mothers and their children over three to five years.

Their paper, "The Mediation of Mothers' Self-Fulfilling Effects on Their Children's Alcohol Use: Self-Verification, Informational Conformity, and Modeling Processes," was recently published in the Journal of Personality and Social Psychology, a professional journal of the American Psychological Association.

Previous research found self-fulfilling prophecy

The team's previous research had found a link between a mother's belief about her child's likelihood of using alcohol and her child's actual use in junior high school and high school.

"We previously found that mothers' beliefs about their teen's future use of alcohol were about 50 percent correct and 50 percent incorrect, and that the incorrect portion of mothers' beliefs created a self-fulfilling prophecy -- teens behaved like their mothers had incorrectly expected them to," Madon said.

Their latest study builds upon those results.

"What we were trying to do in this paper was understand the mechanisms involved in the self-fulfilling prophecy process," Madon said. "We know that mothers have self-fulfilling effects on their kids' alcohol use through the past work that we've done. What we wanted to do here was understand 'How is that happening? What are the mechanisms that are creating that?'

"We derived our hypothesis from three large, well-known theories in the social/psychological literature -- self-verification theory, research on conformity and social learning theory as it pertains to modeling processes," she said.

According to Madon, self-verification theory proposes that people are motivated to confirm what they already believe to be true about themselves. The study found strong evidence that a mother's beliefs regarding her child's likelihood of using alcohol altered her child's self-view in either a positive or negative direction. The child then validated that new self-view by acting consistently with it later on.

"What people believe ultimately has an impact on what actually occurs," Madon said. "But it's not just because they believe it. It's not magic. When we believe something -- even if we're wrong -- when we believe it's true, we act as though it is. And sometimes when you act as though something's true, your behaviors will cause the belief to become true.

"So I think the moral here is to help children develop positive and pro-social self-concepts about themselves, because children are likely to make choices that match how they view themselves," she said.

Kids model their friends' drinking behavior

The study also found some evidence that modeling -- a tendency for people to learn by watching others -- may alter a child's alcohol use. Madon says they had a little bit of support for modeling as it related to friends' alcohol use.

"We hypothesized that mothers may influence who their children are friends with and that children may learn how to behave by watching what their friends do," she said.

But there was no evidence that children conformed their own belief to their mothers' on how acceptable it was for adolescents, in general, to use alcohol.

"How acceptable children thought it was for adolescents to drink alcohol was explained by their own self-views, not by their mothers' beliefs about them. And that's not surprising given that what you think about yourself is going to be strongly tied to what you think is acceptable behavior," Madon said.

She says that it's still a good idea for mothers to instill in their children the belief that adolescent alcohol use is unacceptable, since the study did show a direct effect of teens' perceptions regarding the acceptability of alcohol use on their own drinking.

"The more acceptable teens believed adolescent alcohol use was, the more alcohol they tended to drink themselves," Madon said.
__________
source: Iowa State University

New Drug Arrests Alcohol Addiction in Rats

A compound with fewer side effects offers hope that alcoholism could one day be cured by a pill.

More than 15 million Americans drink too much, according to the National Institute on Alcohol Abuse and Alcoholism. New research on rats may help them curb that addiction.

At present, there are three approved drugs for battling alcoholism, none of which work very well. Among them: naltrexone, which is effective for some alcoholics (as well as opiate addicts) because it blocks a pain pathway in the brain associated with the pleasures of drinking.

In an effort to boost its effectiveness, neuroscientist Selena Bartlett of the Ernest Gallo Clinic & Research Center at the University of California, San Francisco, and her colleagues chemically manipulated naltrexone so that it cut off a related pleasure pathway in the brain. Their findings, published in the journal Biological Psychiatry: rats (trained to crave alcohol) given the new compound, dubbed SoRI-9409, consumed half as much hooch. In addition, there were fewer side effects. Researchers say that unlike naltrexone, this drug did not diminish the animals' desire for water and other nonalcoholic beverages, such as sugar water. "It is much more selective in its effect on drinking," Bartlett says.

Rats given the drug for 28 days refrained from heavy drinking for another four weeks after they were taken off the drug. "That is currently the biggest challenge in alcoholism treatment," which relies primarily on rehabilitation centers, Bartlett notes. When people return home, they typically also return to drinking. "Drinking stays down without the drug in place. It's done something to permanently change and reduce the drinking."

Efficacy trials in humans are already ongoing for another drug known as varenicline, which, in addition to curbing smoking, also cuts drinking. But SoRI-9409 might prove more specifically focused on alcoholism as well as free of some of the side effects reported by those who use varenicline to stop their craving for nicotine.

"We've got a pipeline of different medications targeting different aspects of the disease," Bartlett says. "It's an exciting time for people that suffer from this disease as there are more treatments coming through. Once upon a time, this wasn't really considered possible."
____________
source: Scientific American

Novel Compound Shows Promise for Treatment of Alcoholism

BIRMINGHAM, Ala., Sept 11, 2008 /PRNewswire-USNewswire via COMTEX/ -- - Southern Research Institute and Gallo Research Center today announced that peer-reviewed results from a study testing Naltrexone-derived pyridomorphinan (SoRI-9409) will be published in the December 2008 issue of the journal Biological Psychiatry. The publication is available online today at the journal's website, and suggests that a new compound that causes selective and long-lasting reduction in ethanol consumption might be a promising candidate as a novel treatment for alcoholism.

The article, "A Novel Delta Opioid Receptor Antagonist, SoRI-9409, Produces a Selective and Long-Lasting Decrease in Ethanol Consumption in Heavy-Drinking Rats" by Selena Bartlett, BPharm PhD, Director of Preclinical Development Group at the Gallo Research Center at University of California San Francisco, et al presents the effects of SoRI-9409 on ethanol consumption. These are promising developments for the treatment of alcoholism. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimates 15.1 million people are alcohol-abusing or alcohol-dependent individuals. There are currently only three FDA-approved options for the treatment of alcoholism.

The compound, SoRI-9409, was first designed and synthesized in Southern Research's Drug Discovery research division by Dr. Subramaniam (Sam) Ananthan under U.S. Government Grant DA008883. "Southern Research has been particularly interested in ligands that interact with opioid delta receptor subtype since such ligands hold promise as therapeutic agents for treatment of drug addictions and other disorders," said Dr. Ananthan, senior scientist and manager of Computational Chemistry and CNS Discovery Chemistry at Southern Research Institute. "The present findings by Dr. Bartlett and her group on the effect of SoRI-9409 on its ability to reduce alcohol intake not only provides us with a new drug lead, but also serves as the impetus for further research aimed at discovery of new therapeutic compounds for treating alcoholism and related disorders."

The Preclinical Development Group that Dr. Bartlett leads at the UCSF-affiliated Gallo Center was established to develop new treatments and bridge the gap between research and clinical treatment. The purpose of the study was to find improved compounds for the treatment of alcoholism. "The study results demonstrate that this compound causes selective and long-lasting reductions of ethanol consumption and suggests the compound might be a promising candidate as a novel treatment for alcoholism. This study indicates that compounds with a higher affinity for delta opioid receptors and reduced affinity for mu opioid receptors might be better treatment candidates than Naltrexone, the current FDA approved treatment for alcoholism", said Dr. Bartlett.

"The study on SoRI-9409 and alcohol cessation has yielded vital data that will help fuel novel treatments for a devastating and very difficult-to-treat illness," said Dr. Bartlett. "To date, we have considered and evaluated other compounds, and theories, but the information yielded from this study, along with previous research on this particular compound, has proven to be the most promising to date. We are looking forward to collaborating with our partner, Southern Research, to enter the next phase of research." The research was also supported by the State of California for Medical Research on Alcohol and Substance Abuse and Department of Defense.
Southern Research operates a successful drug discovery research program resulting in six FDA approved drugs with six additional drug candidates in late-stage preclinical and early clinical development.

"Much of our success stems from having a highly successful medicinal chemistry group, and seeking out collaborators who are driven to help us develop new lead compounds and bring those drugs to market," said David Harris, director of Business Development for the Drug Discovery Division at Southern Research. "We're happy to be working with Gallo on this promising new drug to treat alcohol addiction. It is another example of Southern Research's commitment to finding therapies for some of our society's most challenging diseases."

First author on the paper is Carsten Nielsen, PhD, a postdoctoral scientist working with Bartlett. Co-authors are Jeffrey A. Simms, Haley B. Pierson, Rui Li at the Gallo Clinic and Research Center and Surendra K. Saini and Subramaniam (Sam) Ananthan at Southern Research Institute.
___________
source: http://www.marketwatch.com

New Test Effective in Detecting Heavy Drinkers

The sooner alcohol problems are addressed the better the outcome and the less long-term damage is done from excessive drinking. Physicians and healthcare providers now have a new chemical-based test that is more accurate in detecting heavy drinking in their patients. The test can detect heavy drinking episodes in the past four to six weeks.

Physicians and healthcare providers have a new tool which is twice as likely to detect heavy drinking in patients compared to the usual liver enzyme test. The Early Detection of Alcohol Consumption test has been found effective in detecting patients who drink in excess.

The test is used to determine if a patient has engaged in heavy drinking in the previous four to six weeks. Heavy drinking is defined as more than five drinks a day for men and four drinks a day for women.

How The EDAC Test Works

The Early Detection of Alcohol Consumption test is actually an algorithm of 20 blood chemistry levels. Those measurements are compared to a database of more than 1,700 heavy and light drinkers.

Scientists have found that the Early Detection of Alcohol Consumption test is twice as accurate as a liver enzyme test that has been used for years to detect heavy drinking. In one study, 88% of the heavy drinkers and 92% of the light drinkers were correctly identified using the test.

The test is even more effective with patients over 40 years of age.

Early Detection Important
Research has shown that the sooner alcohol problems are addressed the better the outcomes and the less long-term damage. At the 2008 meeting of the American Association for Clinical Chemistry, physicians were encouraged to use the test to increase early intervention with heavy drinkers.

"Physicians can use the test as part of an early intervention," James Harasymiw, director of Alcohol Detection Services, said in an AACC news release. "When patients are confronted with test results, they may be more likely to change their behavior."

"Physicians can show patients the test results to help convince them that their drinking is causing serious damage to their organs and other biologic systems," Harasymiw said.

More Accurate Than Screening Tests?
There are many short alcohol screening tests that are available to screen for alcohol problems in the healthcare setting, but the results of those tests depend upon the patient answering the questions openly and honestly.

Someone trying to cover up or minimize their drinking habits could easily do so with the short-answer screening tests. But the Early Detection of Alcohol Consumption test measures actual blood chemistry levels, making it more difficult for heavy drinkers to hide their consumption.
_______
source: Harasymiw, James W., et al. "Identification of Heavy Drinkers By Using the Early Detection of Alcohol Consumption Score." Alcoholism: Clinical and Experimental Research Volume 25 Issue 2, Pages 228 - 235.

Saving Brains - Fetal Alcohol Syndrome Discovery In Sheep Could Help Humans Soon

In a study on fetal alcohol syndrome, researchers were able to prevent the damage that alcohol causes to cells in a key area of the fetal brain by blocking acid sensitive potassium channels and preventing the acidic environment that alcohol produces. The cerebellum, the portion of the brain that is responsible for balance and muscle coordination, is particularly vulnerable to injury from alcohol during development.

The researchers also found that although alcohol lowers the amount of oxygen in the blood of the mother, it is not the lack of oxygen that damages the fetal cerebellum, but the drop in pH.

Fetal alcohol syndrome is a condition in which maternal drinking during pregnancy injures the brain of the developing fetus. Alcohol is the most common cause of injury to the fetal brain. Children born with fetal alcohol syndrome may have cognitive impairments and difficulty regulating their behavior. They often have difficulty in school and exhibit behavioral problems, such as impulsiveness, later in life.

The syndrome is estimated to occur in approximately one in every 1,000 births in Western countries. Milder forms of the condition, known as fetal alcohol spectrum disorders, occur more frequently.

The study with sheep, published in the August issue of the American Journal of Physiology, demonstrated that the damage can be prevented by blocking acid sensitive potassium channels, known as TASK channels, that lead into the Purkinje cells. The study, "Acid Sensitive Channel Inhibition Prevents Fetal Alcohol Spectrum Disorders Cerebellar Purkinje Cell Loss," was carried out by Jayanth Ramadoss, Emilie R. Lunde, Nengtai Ouyang, Wei-Jung A. Chen and Timothy A. Cudd. The research was done at Texas A&M University.

Maternal drinking lowers the blood pH of both the mother and the fetus, making the blood more acidic. The researchers hypothesized that this acidity damages the Purkinje cells of the fetal cerebellum. Using 56 pregnant sheep, they induced the change in pH in some sheep using alcohol, while in others they manipulated the extracellular pH. This approach allowed them to test their hypothesis that it was the fall in pH that created the damage, not the alcohol, per se.

Alcohol produced a 45% reduction in Purkinje cells of the fetal cerebellum, while the pH changes alone produced a 24% decrease. A drop in the number of Purkinje cells in the cerebellum is a measure of damage.

However, when the researchers used a drug, doxapram, to block the TASK channels leading into the Purkinje cells, they prevented the change in pH in the fetal cerebellar cells and prevented any reduction in the number of these cells.

"This study demonstrates that direct pharmacological blockade of TASK 1 and TASK 3 channels protects the most sensitive target of fetal alcohol exposure, cerebellar Purkinje cells," the authors concluded.

This study complements work by other researchers who have found success with supplements such as choline, a precursor for the neurotransmitter acetylcholine. These supplements may work on the same mechanism that Dr. Cudd's lab has been researching.

Funding: The research was funded by the National Institutes of Health (NIH) Pediatrics Initiatives and the NIH National Institute on Alcohol Abuse and Alcoholism.
_________
source: http://www.scientificblogging.com

NIDA Study Sheds Light on why Addiction is a Chronic Disease

Drug addiction dramatically shifts a person's attention, priorities, and behaviors towards a focus almost entirely on seeking out and taking drugs. Now, an animal study funded by the National Institute on Drug Abuse, part of the National Institutes of Health, has identified some of the specific long-term adaptations in the brain's reward system that may contribute to this shift. These long-lasting brain changes may underlie the maladaptive learning that contributes to addiction and to the propensity for relapse, even after years of abstinence from the drug. The study was published in Neuron on July 30, 2008.

Investigators from the University of California, San Francisco (UCSF) using an animal model of addiction, were able to distinguish brain changes in rats trained to self-administer cocaine, versus those animals that were trained to self-administer natural rewards such as food, or sucrose for several weeks. The investigators also were able to look at how much the "expectation" of receiving the drug influenced those brain changes by comparing rats trained to self-administer the drug versus animals who received the same amount of cocaine, but received it passively, i.e. they could not control their own drug taking by self-administration.

It has been hypothesized that persistent drug seeking alters the brain's natural reward and motivational system. The current study focuses on how drug seeking alters the communication between brain cells in this critical circuitry. In the normal processes of learning and memory formation there is a well documented strengthening of communication between brain cells, this process is known as "long-term potentiation" (LTP). The new study reports that LTP was similar in the rats that had learned to self administer cocaine, food or sucrose, but with a critical distinction. The increase in LTP due to cocaine persisted for up to three months of abstinence, but the increase in response to natural rewards dissipated after only three weeks. Importantly, the nature of the cocaine experience had a strong effect on the outcome, since rats exposed to cocaine when they did not expect it (passive infusions) displayed no LTP, neither transient nor long lasting. Finally, the study showed that LTP in rats that self-administered cocaine persisted after they were trained to stop drug self-administration behaviors. This indicates that, once established, it is very difficult to reverse the "memory trace" associated with drug reward.

"This research provides a better characterization of the variables, at the cellular, circuit, and behavioral level that contribute to the persistent nature of addictive disorders," said Dr. Elias A. Zerhouni, NIH director.

"The researchers were able to illuminate why drug related memories are so stable," said NIDA Director Dr. Nora Volkow. "Their persistence is highly refractory to new learning, which makes our jobs that much tougher, and reminds us that treatment must recognize and address the high propensity for relapse almost anywhere down the road."

"These results indicate that the LTP induced by self administered cocaine is more persistent than that produced by natural rewards, such as food; and that the LTP is not just a result of exposure to cocaine, but also is linked to the drug's effects and the animal's learning to obtain the drug," said Dr. Billy Chen, postdoctoral fellow at UCSF's Ernest Gallo Clinic and Research Center and lead author of the study. "These are important distinctions that will help us better understand how addiction develops, and why drugs can overshadow other natural rewards and become the mainstay of an addicted person's life."

In 2006, six million Americans age 12 and older had abused cocaine in any form. There are currently no medications for cocaine addiction, therefore standard treatments typically rely on behavioral interventions. However, relapse after treatment for cocaine addiction is common.
____________________
The National Institute on Drug Abuse is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world's research on the health aspects of drug abuse and addiction. The Institute carries out a large variety of programs to ensure the rapid dissemination of research information to inform policy and improve practice. Fact sheets on the health effects of drugs of abuse and further information on NIDA research can be found on the NIDA web site at http://www.drugabuse.gov.

The National Institutes of Health (NIH) - The Nation's Medical Research Agency - includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary Federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov
_______
source: NIDA

Agency Wants to Help Doctors Identify Heavy Drinkers and Get Them Treatment Promptly

When it comes to treatment, the experts think alcoholism needs to catch up to depression.

Three decades ago, long before the dawn of the Prozac Era, depression was a disease rarely treated in its mild form, reluctantly treated with drugs and usually treated by experts only. Today, signs of depression are actively sought, drugs are prescribed early and often, and most cases are handled by non-psychiatrists.

With alcohol abuse, however, most physicians don't go looking for trouble and don't recognize it until it's breathing in their face. Over-drinking patients often don't think of looking for help even if they know they are heading in the wrong direction. And society as a rule looks at alcohol treatment as a last-chance, 90-degree corner taken only at high speed.

All this will change if American physicians adopt the new guidelines for "Helping Patients Who Drink Too Much" promulgated by the National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health.

The idea is to simplify the screening for excessive alcohol use in general medical practice and to convince clinicians and patients that early intervention for drinking that hasn't yet wreaked havoc is both possible and useful.

"We're trying to increase the accessibility and attractiveness of treatment to a much broader spectrum of people," said Mark L. Willenbring, a psychiatrist who directs the Division of Treatment and Recovery Research at NIAAA.

Those especially targeted in the guidelines are heavy drinkers who are not yet physically dependent on alcohol but are at risk for becoming so.

"We know that that group responds very, very well to what we call facilitated self-change and brief motivational counseling. We could make that very widely available without much cost," Willenbring said.

A big part of the new strategy is to make primary care physicians -- people without specialized training in addiction medicine -- think about alcohol abuse the way many now think about depression, anxiety and obsessive-compulsive disorder. Which is to say, they need to think of it as something common, diagnosable and within their capacity to treat. The guidelines make this easy: The screening tool for alcohol problems consists of a single question. For men: How many days in the past year have you had five or more drinks? For women: How many days in the past year have you had four or more drinks?

"Most doctors don't know how to make the diagnosis and don't really try to do anything about it until it is so easy to diagnose that all you have to do is glance at the patient," said Charles P. O'Brien, a professor of psychiatry at the University of Pennsylvania who has been treating alcoholics for 38 years.

"It used to be said that you can't treat somebody until they are down and out. But when they are down and out, they are really hard to treat," O'Brien said.

Willenbring concurs.

"I think there is a belief that people with more moderate levels of dependence don't know they have a problem. I think they do. But they don't think rehab is the model of treatment for them -- and I don't, either."

The sort of therapy both advocate does not involve magic bullets or easy answers or effortless behavior change. But it does enlist pills that help a little, quite a bit of talk and lots of self-discipline.

And what does it get a person?

Perhaps not surprisingly, there's evidence that getting control of a drinking problem early can improve one's health, completely apart from the social, psychological and familial benefits it brings.

A study published two years ago looked at the experience of 628 men and women who entered alcoholism treatment (either in residential rehab or as outpatients) in their mid-30s and were followed for 16 years.

Over that period, 121 died, or 1.2 percent a year. The average age of death was 48. But the chance of dying was significantly lower in people who after the first year were abstinent or had no drinking-related problems or symptoms.

So how successful is treatment, or at least how successful has it been?

Researchers in 2000 analyzed seven studies, one going back to the late 1970s, in which more than 8,000 people were treated for alcoholism in various ways, including with drugs. After a single course of treatment, one-fourth were abstinent for at least a year and one-tenth dramatically decreased their drinking. The rest, about two-thirds of the subjects, drank less often and in quantities averaging less than half of what they consumed before treatment. Mortality in the first year was 1.5 percent.

Some of those patients had a four-week stay in "rehab," but most did not. A long treatment-center admission as the optimal strategy to stop a serious drinking problem is much more the model of the 1980s than the 2000s. The newer one emphasizes outpatient treatment -- occasionally after a brief hospital stay for acute detoxification, if necessary -- with care provided by non-specialists in many cases.

How often contemporary treatment succeeds was also explored in a complicated clinical trial of about 1,400 alcohol-dependent men and women, average age 44 and consuming 12 drinks a day, that was published in the Journal of the American Medical Association in 2006.

The researchers randomly assigned the patients to nine groups. Four of the groups got nine sessions, conducted by a doctor or nurse and lasting at least 20 minutes, that reviewed the health consequences of excessive drinking, encouraged abstinence and attendance at Alcoholics Anonymous meetings, and urged adherence to the study medicines. Four of the groups also got intensive counseling by alcohol-addiction experts -- up to 20 hour-long sessions.

Some of the patients were assigned to take a drug for three months: either naltrexone, which blocks opiate receptors in the brain that are involved in alcohol's "reward pathways," or acamprosate, which works through so-called GABA receptors to decrease the anxiety and restlessness that can come with abstinence. Some got placebo pills.

A year later, there were no big differences among any of the groups, although there were some interesting small ones. (This was true even with what the researchers considered the placebo group, the people who received specialized alcohol counseling but no time with a physician and no pills.)

People who met regularly with a doctor or nurse and then got either naltrexone or the intensive counseling did equally well; about 66 percent were abstinent. People who had those sessions and got placebos did less well; 59 percent were abstinent. Those who got intensive counseling but no pills, neither active ones nor placebos, had an intermediate outcome, with 62 percent abstinent.

Unlike some other studies, this one showed no benefit from acamprosate. But that may not be the last word.

A clinical trial not yet published showed the drug worked only when started during a period of abstinence, not while a person was still drinking. And last month researchers reported more evidence that GABA receptors play a role in alcohol addiction. Laboratory rats that got the drug gabapentin, which enhances the action of GABA, drank less -- but only if they were already chronically exposed to alcohol. Those that used alcohol only occasionally did not show such an effect, suggesting the preexisting state was crucial to the response.

Abstinence, in almost all practitioners' minds, is always the goal. But its absence doesn't signal abject failure.

"It is a fiction that the typical change process is a sudden transformation," Willenbring said. "The more common is a change process that lasts years and is characterized by lengthening periods of sobriety and shorter relapses until they are gone."

In that way, alcohol abuse is like depression. In another way, too.

"Recovery from depression requires effort. The same is true for alcohol dependence," he said.

And in both cases, he thinks they're really worth the effort.
__________
source: The Washington Post

Researchers: Liver Cancer Kills 40,000 a Year in Europe

More than 6,000 physicians and scientists gathered in Milan, Italy, to attend the 43rd annual meeting of the European Association for the study of the liver to discuss liver disease and treatment improvements.

Liver cancer takes about 40,000 lives a year and liver disease caused by alcohol abuse takes some 13,000 in the European Union, researchers say.

More than 6,000 physicians and scientists from around the world are gathered in Milan, Italy, to attend the 43rd annual meeting of the European Association for the study of the liver to discuss liver disease and treatment improvements.

Acute and chronic conditions affecting the largest internal organ of the body includes diseases that typically result from inflammation or infection due to injurious agents such as viruses, alcohol and drugs.

The most prominent conditions -- each of which may arise in an acute form but then progress to a chronic state -- are alcoholic liver disease; hepatitis B, C, and D; non-alcoholic fatty liver disease and NASH, or non-alcoholic steatohepatitis, the most severe subset of non-alcoholic fatty liver disease.

There are continuing declines in new cases of hepatitis B and C, but stability or increases in fatty liver disease due either to excessive consumption of alcohol or non-alcoholic causes non-alcoholic fatty liver disease, one of the opening presentations said.

source: United Press International

A Closer Look: Alcohol And Breast Cancer Link

It's elementary. If you smoke, you are at greater risk for certain kinds of cancer. But how about this: you drink and you're at a greater risk of breast cancer. That's based on a bold new study making a lot of waves in the medical community. We wanted to give you a closer look at what this study actually means through the eyes of doctors.

The study looked at more than 184,000 post-menopausal women.

"That number of people being studied is immense and that really lends a lot of credibility," said KLTV 7 med-team Dr. Ed Dominguez.

And the results are jaw-dropping. Consume one or two drinks a day and you're looking at a 32% greater risk of developing breast cancer. Make it three or more drinks, and that risk shoots up to over 50%.

"When a post-menopausal woman drinks alcohol and if she has an enzyme, or the ability to metabolize that alcohol quickly, and people will metabolize that at different rates, the faster that woman will metabolize that the higher her risk of breast cancer," said Dominguez.

Some doctors said they're shocked by the study.

"All this is people sitting around in a room scratching their chins going 'how do we explain this?' I mean, you cannot say at this point this is proof positive," said Dr. Gary Gross from the Blood & Cancer Center of East Texas.

Gross said while the findings are interesting, more research is needed to confirm the link.

"I could count on one hand probably the women I've treated for breast cancer who I knew were alcoholics," said Gross. "The vast majority say they don't drink or they have an occasional social drink."

Regardless of the research, women are urged to know their risks. If you have a family history of breast cancer, doctors said it's a good idea to avoid alcohol completely. They also still said, one drink a day will reduce cholesterol and your risk of developing heart disease.

This study was led by a doctor from the U.S. National Cancer Center Institute. The findings are expected to be presented this weekend at the annual meeting of the American Association For Cancer Research.

source: http://www.kltv.com

Genetic Factor In Stress Response Variability Discovered

Inherited variations in the amount of an innate anxiety-reducing molecule help explain why some people can withstand stress better than others, according to a new study led by researchers at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health (NIH).

"Stress response is an important variable in vulnerability to alcohol dependence and other addictions, as well as other psychiatric disorders," noted NIAAA Director Ting-Kai Li, M.D. "This finding could help us understand individuals' initial vulnerability to these disorders."

Scientists led by David Goldman, M. D., chief of the NIAAA Laboratory of Neurogenetics, identified gene variants that affect the expression of a signaling molecule called neuropeptide Y (NPY). Found in brain and many other tissues, NPY regulates diverse functions, including appetite, weight, and emotional responses.

"NPY is induced by stress and its release reduces anxiety," said Dr. Goldman. "Previous studies have shown that genetic factors play an important role in mood and anxiety disorders. In this study, we sought to determine if genetic variants of NPY might contribute to the maladaptive stress responses that often underlie these disorders." A report of the findings appears online today in Nature.

Analyses of human tissue samples led by researchers at NIAAA identified several NPY gene variants. Collaborations with NIH-supported scientists at the University of Michigan, University of Pittsburgh, University of Helsinki, University of Miami, University of Maryland, the University of California at San Diego, and Yale University, showed that these variants result in a range of different effects including altered levels of NPY in brain and other tissues, and differences in emotion and emotion-induced responses of the brain.

The researchers evaluated the NPY gene variants' effects on brain responses to stress and emotion. Using functional brain imaging, they found that individuals with the variant that yielded the lowest level of NPY reacted with heightened emotionality to images of threatening facial expressions. "Metabolic activity in brain regions involved in emotional processing increased when these individuals were presented with the threatening images," explained Dr. Goldman.

In another brain imaging experiment, people with the low level NPY variant were found to have a diminished ability to tolerate moderate levels of sustained muscular pain. Previous studies had shown that NPY's behavioral effects are mediated through interactions with opioid compounds produced by the body to help suppress pain, stress, and anxiety. "As shown by brain imaging of opioid function, these individuals released less opioid neurotransmitter in response to muscle discomfort than did individuals with higher levels of NPY," said Dr. Goldman. "Their emotional response to pain was also higher, showing the close tie between emotionality and resilience to pain and other negative stimuli."

In a preliminary finding, the low level NPY gene variant was found to be more common than other variants among a small sample of individuals with anxiety disorders. The researchers also found that low level NPY expression was linked to high levels of trait anxiety. "Trait anxiety is an indication of an individual's level of emotionality or worry under ordinary circumstances," explained Dr. Goldman.

The researchers conclude that these converging findings are consistent with NPY's role as an anxiety-reducing peptide and help explain inter-individual variation in resiliency to stress. "This inherited functional variation could also open up new avenues of research for other human characteristics, such as appetite and metabolism, which are also modulated by NPY," said Dr. Goldman.

source: Science Daily

Self Experimenters: To Purge Binges, Alcoholic Cardiologist Self-Prescribed an Experimental Drug

The last time Olivier Ameisen formally practiced medicine was in the early summer of 1997. After two decades in the field, the French-born physician, then running a clinic on Manhattan's Upper East Side, abruptly rang up his secretary one morning and told her to clear his schedule. She laughed in disbelief when he explained why. He was ill, he told her; he was an alcoholic, and he was afraid his drinking might interfere with his patients' care.

Anyone familiar with his resume would have responded the same way. Ameisen was a stellar medical student at the University of Paris—which he entered at the age of 16. Moving to the U.S., he began a fellowship in 1983 at New York–Presbyterian Hospital in Manhattan, swiftly becoming an attending physician there in 1986. (The same year, he added teaching appointments at the hospital-affiliated Weill Cornell Medical College of Cornell University.)

But things began to sour in 1994, when the then 41-year-old bachelor opened a private practice. Although the venture was initially successful—he broke even in four months instead of the usual two years—he became gripped by an irrational fear that he might not be able to provide for a future family. "That's when I started binging at home," says Ameisen, now 54. As time went by, "my fear," he says, "was to be drunk and have a patient call me and say, 'I have chest pain,' and have me tell him, 'Okay, go play tennis.'"

After putting his practice on hold, Ameisen spent nine months over two years in various rehab clinics trying to quell his alcohol cravings, or "motivations," as he calls them. He gave Alcoholics Anonymous a shot—or more like a round of shots; he estimates that in a single year he went to 700 meetings, as often as four a day. He also tried naltrexone and acamprosate, the only two drugs approved by the U.S. Food & Drug Administration to treat alcohol dependency, without success.

Finally, convalescing in Paris in 2004 (where he went to be close to his parents and relatives), he read about a study of a muscle relaxant that had stifled the cravings of a cocaine addict. The drug, baclofen, had also shown efficacy against anxiety and depression. Eager to try it, he prescribed a high dosage for himself. Within a few months of starting the regimen, his craving for drink evaporated. Fourteen months into his self-experiment, he published a case study of his self-treatment in the journal Alcohol and Alcoholism, and he is now writing a book called The End of My Addiction, chronicling his successful journey.

Researchers believe that baclofen may increase the brain's levels of the neurotransmitter GABA (gamma-aminobutyric acid), involved in regulating the desire for addictive substances, by stimulating a subset of GABA receptors. But, contrary to Ameisen's experience, a recent double-blind study of 80 alcoholics at the University of North Carolina School of Medicine in Chapel Hill found no difference in outcome between those taking baclofen or a placebo. Ameisen points out, however, that the dosage of 30 milligrams a day given to study participants was far lower than his up to 270-milligram daily dose, which studies had shown people could tolerate without displaying side effects such as somnolence and muscle weakness.

"The story on baclofen is really still out," says James C. Garbutt, a U.N.C. psychiatry professor and senior investigator on the study. He notes that the drug may reduce the anxiety and insomnia that often accompany alcohol withdrawal, which might ease the transition to sobriety, but adds that researchers cannot accurately predict who might benefit from the drug absent a larger study.

Still, Ameisen insists that for him the drug was a lifesaver. Now, instead of downing a quart and a half of Scotch a day, he takes as little as 70 milligrams of baclofen. He is contemplating a return to medicine, he says, but for now he takes satisfaction in corresponding with addiction researchers from his Paris apartment and encouraging them to conduct further clinical trials of baclofen.

"I know that case reports are there" on baclofen's efficacy, Ameisen notes. "But, even if you have 10 case reports, that's no better than one."

source: Scientific American

Drunkorexia

MANOREXIA. Orthorexia. Diabulimia. Binge Eating Disorder.

All are dangerous variations on the eating disorders anorexia and bulimia, and have become buzzwords that are popping up on Web sites and blogs, on television and in newspaper articles. As celebrity magazines chronicle the glamorous and the suffering, therapists and a growing number of researchers are trying to treat and understand the conditions.

The latest entry in the lexicon of food-related ills is drunkorexia, shorthand for a disturbing blend of behaviors: self- imposed starvation or bingeing and purging, combined with alcohol abuse.

Drunkorexia is not an official medical term, but it hints at a troubling phenomenon in addiction and eating disorders. Among those who are described as drunkorexics are college-age binge drinkers, typically women, who starve all day to offset the calories in the alcohol they consume. The term also is associated with serious eating disorders, particularly bulimia, which often involve behavior like bingeing on food - and alcohol - and then purging.

Anorexics, because they severely restrict their calorie intake, tend to avoid alcohol, but some drink to calm down before eating or to ease the anxiety of having indulged in a meal. Others consume alcohol as their only sustenance. Still others use drugs like cocaine and methamphetamine to suppress their appetites.

"There are women who are afraid to put a grape in their mouth but have no problem drinking a beer," said Dr. Douglas Bunnell, the director of outpatient clinical services for the Renfrew Center, based in Philadelphia.

The center, like a small but growing number of eating-disorder and addiction-treatment facilities, most on the West Coast, offers a dual focus on substance abuse and eating disorders.

Bunnell, former president of the National Eating Disorders Association, said the obsession with being skinny and the social acceptance of drinking and using drugs - along with the sense, lately, that among celebrities, checking into rehab is almost a given, if not downright chic - are partly to blame.

"Both disorders are behaviors that are glorified and reinforced. Binge drinking is almost cool and hip, and losing weight and being thin is a cultural imperative for young women in America. Mixing both is not surprising, and it has reached a tipping point in terms of public awareness."

Psychologists say that eating disorders, like other addictions, are often rooted in the need to numb emotional pain with substances or the rush provided by bingeing and purging. The disorders are often driven by childhood trauma like sexual abuse, neglect and other sources of mental anguish.

Manorexia is the male version of anorexia. Orthorexia is an obsession with what is perceived as healthy food - eliminating fats and preservatives, for example. But people with this condition can dangerously deprive themselves of needed nutrients.

Diabulimia refers to diabetics who avoid taking insulin, which can cause weight gain, to control their weight. Despite the name, the disorder does not typically involve purging.

Binge Eating Disorder refers to obsessive overeating, especially of foods high in salt and sugar, that does not involve excessive exercise or purging to compensate for the high caloric intake.

Judy Van De Veen, 36, who lives in Gillette, N.J., became anorexic at 24. She said she starved herself, meting out small bites of low-calorie food for two months. Then she began bingeing and purging, throwing up entire boxes of cereal, whole pizzas and fast food from drive-throughs that sometimes cost her $80 a day.

She went into treatment, both inpatient and outpatient, for her eating disorder for several years in the late 1990s, with mixed results. In 2001, still struggling with bulimia, she took up drinking. If she ate while drinking, she said, she would purge, but then consume more alcohol to make up for the loss, because she wanted to remain drunk.

Many bulimics who drink use alcohol to vomit, experts on eating disorders say, because liquid is easier to purge. They also tend to vomit because they often drink on empty stomachs.

"In the beginning of my eating disorder I wouldn't touch alcohol because it is so high in calories," said Van De Veen, who later found herself regularly hospitalized for dehydration.

"But I have the disease of more: I just want more no matter what it is."

Two years into her drinking problem, she joined a 12-step program. She spent the next two years in and out of six residential rehab programs, spending about $25,000 of her own money because she didn't have health insurance. But none of the programs were equipped to address eating disorders, so she binged and purged and her eating disorder raged.

Van De Veen said she has been sober for three years, but is still struggling with bulimia. She now has a 14-month-old daughter, Cheyenne, and she said that her pregnancy and support groups had helped her make progress on her eating disorder.

"I had an excuse to eat," she said of being pregnant. "I didn't care and I loved it."

But she said the temptation to binge and purge is haunting her again.

Trish, 27, who has had an eating disorder for 10 years, recently checked into Renfrew, her fifth stint in a treatment center or hospital.

Like Van De Veen, Trish, who agreed to be interviewed on the condition that only her first name be used to protect her privacy, struggled with anorexia first and then found alcohol. Before she was admitted to Renfrew, she said she was blacking out from lack of food and suffering from excruciating stomach pain.

Trish, a nurse who lives in Ohio and works with cardiac patients, said she would starve herself through her 8- or 12-hour shifts, staring at the clock and fixating on when she could have her first drink.

Drinking, she said, relaxed her when she had to eat in front of other people, a huge source of stress.

"The alcohol is probably what kept any weight on me," she said in an interview in February at the Renfrew Center, which she entered on New Year's Eve for eight weeks of treatment.

"Drinking helped me be less anxious,. It helped me be more of Trish. The two go together: If I drink more, I'm more into my eating disorder and vice versa."

Studies show that binge drinking and alcohol abuse are on the rise among women, who also are more prone than men to eating disorders.

About 25 percent to 33 percent of bulimics also struggle with alcohol or drugs, according to a study published last year in the journal Biological Psychiatry. Between 20 percent and 25 percent of anorexics have substance abuse problems, the study found.

A growing number of researchers are examining the psychological and neurological links between eating disorders and substance abuse: Does eating a chocolate bar, or bingeing and purging, stimulate the same pleasure centers in the brain as drugs or alcohol?

Dr. Suzette M. Evans, a professor of clinical neuroscience at Columbia University, recently began a study of the connection between bulimia and substance abuse, a field she said has been neglected.

"People are finally beginning to realize that food can function in the same way as drugs and alcohol."

As more patients seek treatment for both eating disorders and substance abuse, a complicated set of mixed messages can arise. The response to addiction is abstinence; but quitting food is not an option.

"We're trying to get our patients to find effective behaviors and life skills," said Dr. Kevin Wandler, the vice president for medical services at Remuda Ranch, which addresses eating disorders and addiction at its facilities in Arizona and Virginia, near Bowling Green.

"Eating normally would be an effective behavior, but it's easier to give up alcohol and drugs because you never need it again. If your drug is food, that's a challenge."

By Sarah Kershaw

The New York Times

Islander brings scientific awareness to the epidemic of alcoholism

Psychologist Santi Meunier has spent most of her adult life exploring the ravages of substance abuse. In her new book, "Dying for A Drink: the Hidden Epidemic of Alcoholism," Meunier presents hard evidence that proves alcoholism is not simply a bad choice, but a disease resulting from a combination of genetic, physical, and psychological factors. Environmental, social and spiritual factors also play a strong role in alcohol addiction, according to the book.

Citing references to a variety of medical and scientific periodicals, Meunier packs a systematic punch into her book. "I want to dispel the myths about alcoholism," Meunier notes. She brings to light that alcoholism is no longer thought of as a subjective diagnosis, but as a medical diagnosis of a brain disorder. "There's so much stigma and judgment in our society related to alcoholism. I want to clarify why it is a disease."

Research of alcohol dependency has become more sophisticated, Meunier continues. Scientists are working to isolate the alcohol gene. In the next few years, an actual test will be able to prove alcohol is chemically connected. "We are basically chemistry," she points out.

Meunier has worked in the field of recovery for over 20 years, holding a long track record of private practice with troubled families. She points out that alcoholism ruins families, friendships, jobs and health. "Alcoholism is a three-fold disease. There is a physical addiction, an emotional dependency and a soul sickness, or spiritual dependency," she says.

As part of her scientific approach, Meunier has developed a series of practical concepts and solutions she presents through speaking engagements and private practice. Her methods show how society stays emotionally blackmailed through addiction.

"Three outcomes are imminent for the alcoholic: finding success in a recovery program, being institutionalized or jailed, or facing an early death," she says. Her own step by step guide called the Holographic Treatment Program helps people who want more than "okay" sobriety, Meunier explains.

Meunier has moved from her personal experience of witnessing the devastating effects of alcohol in her own family to pioneering her three-level outpatient recovery program for adult children of alcoholics. She has helped troubled adolescents through developing abuse and addiction recovery programs for several residential schools.

Meunier has found through her research that relapse of alcohol abuse is very high, and has pushed on to research why. "We are not dealing with the problem holistically," she notes. Meunier recalls the 'Just Say No' program from the 1980s, saying, "It was a good start, but it did not look at why children start drinking." The average age that boys start drinking, she adds, is 11. "If the brain chemistry is low, that group will try to selfmedicate," she explains. "They take the drink, and the chemical level goes up. For the first time, they have a feel-good chemistry." But over time, the chemistry level drops lower, creating more imbalance.

Those already familiar with Meunier's work have witnessed how her program, "Practical Spirituality for Fearless Living," uses ground-breaking tools for personal and professional growth. She notes that fear is the ultimate robber that keeps us from fulfilling our life purpose. "The world needs us to be a success," she adds.

Meunier is planning a series of speaking engagements geared toward high school- and middle school-aged children. She also plans corporate seminars that address addiction in the workplace. "The amount it costs us as a society is huge," she says. "I am becoming a spokesperson for the reality and solutions in an addicted society."

Meunier's book is now available online at the publisher's Web site, www.iUniverse.com, and also can be ordered through Amazon Books or any Barnes and Noble outlet. Jamestowners may order signed copies directly from the author by calling her at 667-7399, or visiting her new Web site, www. santimeunier.com, which is expected to be online in March.
___
source: http://www.jamestownpress.com

Does The Desire For Drugs Begin Outside Awareness? NIDA Research Reveals Subconscious Signals Can Trigger Drug Craving Circuits

Using a brain imaging technology called functional magnetic resonance imaging (fMRI), scientists have discovered that cocaine-related images trigger the emotional centers of the brains of patients addicted to drugs -- even when the subjects are unaware they've seen anything. The study, published Jan. 30 in the journal PLoS One, was funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH).

A team of researchers at the University of Pennsylvania, led by Dr. Anna Rose Childress and Dr. Charles O'Brien, showed cocaine patients photos of drug-related cues like crack pipes and chunks of cocaine. The images flashed by in just 33 milliseconds -- so quickly that the patients were not consciously aware of seeing them. Nonetheless, the unseen images stimulated activity in the limbic system, a brain network involved in emotion and reward, which has been implicated in drug-seeking and craving.

"This is the first evidence that cues outside one's awareness can trigger rapid activation of the circuits driving drug-seeking behavior," said NIDA director Dr. Nora Volkow. "Patients often can't pinpoint when or why they start craving drugs. Understanding how the brain initiates that overwhelming desire for drugs is essential to treating addiction."

To verify that the patterns of brain activity triggered by the subconscious cues reflected the patients' feelings about drugs, Childress and her colleagues gave the patients a different test two days later, allowing them to look longer at the drug images. The patients who demonstrated the strongest brain response to unseen cues in the fMRI experiment also felt the strongest positive association with visible drug cues. Childress notes, "It's striking that the way people feel about these drug-related images is accurately predicted by how strongly their brains respond within just 33 milliseconds."

Childress and her colleagues also found that the regions of the brain activated by drug images overlapped substantially with those activated by sexual images. This finding supports the scientific consensus that addictive drugs usurp brain regions that recognize natural rewards needed for survival, like food and sex.

According to Childress, these results could improve drug treatment strategies. "We have a brain hard-wired to appreciate rewards, and cocaine and other drugs of abuse latch onto this system. We are looking at the potential for new medications that reduce the brain's sensitivity to these conditioned drug cues and would give patients a fighting chance to manage their urges."

Click here to view paper...

The National Institute on Drug Abuse is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world's research on the health aspects of drug abuse and addiction. The Institute carries out a large variety of programs to inform policy and improve practice. Fact sheets on the health effects of drugs of abuse and information on NIDA research and other activities can be found on the NIDA home page at www.drugabuse.gov.

Alcoholism Definition Becoming Fuzzier

The definition of alcoholism isn't as cut-and-dried as it's been. New studies are prompting experts to reassess exactly what does and doesn't constitute being an alcoholic.

On The Early Show Wednesday, Ph.D., Co-founder and Clinical Director for the Center for Motivation and Change, Carrie Wilkens, told co-anchor Julie Chen, "What's really changed is whether or not people need to sign on for the label of 'alcoholic' in order to get help with their alcohol problems."

Wilkens, who's with the Center for Motivation and Change in Manhattan, explained that, "Alcohol problems fall in a wide spectrum. Some people are drinking relatively low amounts, but incurring consequences that will really add up over the course of time to really harm their lives, all the way to people who are drinking quite a lot and suffering very serious consequences that need to be addressed more directly."

According to The Wall Street Journal, "More than 30 percent of Americans engage in risky drinking at some point in their lives, according to the National Institute on Alcohol Abuse and Alcoholism. But there's no consensus on exactly what an 'alcoholic' is."

The Journal says some experts want "the authoritative American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders" in an edition being compiled "to combine abuse and dependence into a single 'alcohol-use disorder' that ranges in severity, taking into account harmful drinking patterns and other symptoms. The aim is for simmering problems to be spotted sooner."

The Journal adds, "NIAAA officials say that, in recognizing a drinking problem, the label 'alcoholic' is less important than harmful patterns of drinking, which they describe as drinking too much, too fast or too much, too often."

"If you're worried that you may be drinking too much, you've already met a key criterion on some screening tests," the Journal points out.

Wilkens says much of it comes down to the consequences of drinking. For instance, "You don't like it when you're wife is upset, you don't like the groggy way you feel, those ten extra pounds because of drinking. Some people will be incurring lots of consequences, even though they hate the way they feel. And they end up doing same thing again, at greater risk."

Wilkens noted to Chen that it generally takes less for women "to start to have problems with alcohol. She will require fewer drinks in order to get there. ... (It's recommended that) women don't drink any more than seven drinks per week and no more than three drinks in a sitting. Whereas, men can drink up to 14 drinks a week without suffering physical consequences associated with their alcohol use, because (women's) bodies just process alcohol differently. We become intoxicated more quickly."

But simply exceeding those guidelines "doesn't necessarily mean you are an alcoholic," Wilkens observed. "It might mean that it's worth slowing down a little bit and assessing, 'Am I having some consequences associated with my alcohol use that are really upsetting me, and maybe I need to slow down a little bit and reset my limits. Maybe I need to get a little extra help with it. Maybe I need to re-evaluate my relationship (with alcohol).' It doesn't mean you are necessarily an alcoholic."

A well-known quickie quiz is called The Cage Test.

"C": Have you ever felt you should cut down on your drinking?
"A": Have people annoyed you by criticizing your drinking?
"G": Have you ever felt bad or guilty about your drinking?
"E": Eye-opener: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

"Answering 'yes' to even one of these questions," concluded Wilkens, "suggests you should look at your alcohol use and just question whether or not you need to do something about it."

source: CBS News

Doctors Underestimate the Power of Screening for Problem Drinking

A 10-minute screening and talk with a doctor about problem drinking delivers almost as much bang for the buck to the health system as childhood immunization and advice about taking aspirin to prevent stroke and heart attack, according to a new systematic review — but just 8.7 percent of problem drinkers report receiving such information.

The review, which appears in the February issue of the American Journal of Preventive Medicine, included data from 10 randomized controlled trials of alcohol problem screening and advice by primary care doctors.

“Reviewing this data and stepping back, it really struck me how truly important this finding is,” said lead author Leif Solberg, M.D., associate medical director for care improvement research at Health Partners in Minneapolis. “It’s a service most physicians don’t offer.” Solberg added that most doctors now recognize the importance of offering advice on quitting smoking, but with drinking, physicians are not onboard.

“I think most of my fellow physicians would think that their impact on alcohol use is close to zero,” he says.

“Alcohol screening and brief therapy are very cost-effective compared to other recommended medical services, yet they are employed least often of any of them,” said Alex DeLuca, M.D., former chief and medical director of the Smithers Addiction Treatment and Research Center in New York, who was not involved with the systematic review.

Brief intervention for alcohol is in the top-five most cost-effective preventive services, according to the research — coming in equal to or higher than many common screening services like Pap smears and bowel cancer screening.

DeLuca said of the review, “The analysis of cost-effectiveness was sophisticated and appropriate, and the calculations for alcohol services were comparable to the other services, supporting the relevance of the overall model and methodology used. The article supports prioritizing alcohol screening and counseling.”

The review found that screening and brief counseling reduced problem drinking by 17.4 percent over a period that varied from six months to two years among studies. This means that more than one in six problem drinkers who received these brief interventions no longer fit that definition six months to two years later.

Although that might seem like a small reduction, with one-fourth of people aged 18 to 54 engaging in problem drinking, cutting the numbers by that amount results in a large effect on the population as a whole.

Review studies relied on different definitions of problem drinking, but the task force viewed it as drinking more than seven drinks per week for women or more than 14 for men — or drinking more than three drinks on one occasion for women or four drinks per occasion for men. It includes risky behaviors such as drinking and driving, and binge drinking, which are not severe enough to meet the criteria for alcoholism or alcohol dependence.

Some reasons physicians tend not to screen for alcohol problems in general practice are a sense that a short talk with a doctor will not help alcoholics quit and a perception that those who are not alcoholics do not need advice on cutting back or stopping drinking.

However, Solberg said, “The value of this service comes without the difficulty of treating dependence — this is problem drinking.” Study co-author, Michael Maciosek, Ph.D., research investigator at Health Partners, added, “The effectiveness does not depend on stopping drinking — it’s reducing the quantity or the number of times there is binge drinking.”

DeLuca said that many physicians are afraid of getting involved in “lengthy, uncomfortable encounters” with patients who could be defensive about drinking too much and they are generally pessimistic about the outcomes of treatment for alcohol problems, despite the strong research support for both brief interventions for problem drinkers and other therapies for alcoholics.

In terms of costs, the review found that each screening and counseling session cost about $10 per patient and saved the health care system about the same amount over five years in terms of reduced costs due to accidents, injuries and other alcohol-related health problems. It did not include savings due to possible health benefits of moderate drinking.

“Physicians do not screen for substance use disorders enough or provide brief counseling – even though if they did, many, many people would be spared much misery and illness and cost. So, patients, if the docs won’t bring it up, you should,” DeLuca advised.

source: Health Behavior News Service

Brain imaging shows there may be a cognitive difference in people with addictions

Scientists have for the first time identified brain sites that fire up more when people make impulsive decisions.

In a study comparing brain activity of sober alcoholics and non-addicted people making financial decisions, the group of sober alcoholics showed significantly more "impulsive" neural activity.

The researchers also discovered that a specific gene mutation boosted activity in these brain regions when people made impulsive choices. The mutation was already known to reduce brain levels of the neurotransmitter dopamine. The newly found link involving the gene, impulsive behavior and brain activity suggests that raising dopamine levels may be an effective treatment for addiction, the scientists say.

The research is reported in the Dec. 26, 2007 issue of the "Journal of Neuroscience."

Lead scientist is Charlotte Boettiger, PhD, assistant professor of psychology at the University of North Carolina at Chapel Hill. Boettiger led the research as a scientist at UCSF's Ernest Gallo Clinic and Research Center. Senior author is Howard Fields, MD, PhD, a UCSF professor of neurology and an investigator in the Gallo Center. He also serves as director of the UCSF Wheeler Center for the Neurobiology of Addiction.

"Our data suggest there may be a cognitive difference in people with addictions," Boettiger said. "Their brains may not fully process the long-term consequences of their choices. They may compute information less efficiently."

"What's exciting about this study is that it suggests a new approach to therapy. We might prescribe medications, such as those used to treat Parkinson's or early Alzheimer's disease, or tailor cognitive therapy to improve executive function" she added.

"I am very excited about these results because of their clinical implications," Fields said. "The genetic findings raise the hopeful possibility that treatments aimed at raising dopamine levels could be effective treatments for some individuals with addictive disorders."

The scientists used functional magnetic resonance imaging, or fMRI, to image brain activity while subjects were faced with a hypothetical scenario: choose less money now, or more money later.

Boettiger recruited 24 subjects:19 provided fMRI data, 9 were recovering alcoholics in abstinence and 10 had no history of substance abuse. Another five were included in the genotyping analysis.

At the fMRI research facility at the University of California, Berkeley, financial decision tasks measured rational thinking and impulsivity. Sober alcoholics chose the "now" reward almost three times more often than the control group, reflecting more impulsive behavior.

While decisions were being made, the imaging detected activity in the posterior parietal cortex, the dorsal prefrontal cortex, the anterior temporal lobe and the orbital frontal cortex. People who sustain damage to the orbital frontal cortex generally suffer impaired judgment, manage money poorly and act impulsively, the scientists noted.

The study revealed reduced activity in the orbital frontal cortex in the brains of subjects who preferred "now" over "later," most of whom had a history of alcoholism.

The orbital frontal cortex activity may be a neural equivalent of long-term consequences, Fields said.

"Think of the orbital frontal cortex as the brakes," Boettiger explained. "With the brakes on, people choose for the future. Without the brakes they choose for the short-term gain."

The dorsal prefrontal cortex and the parietal cortex often form cooperative circuits, and this study found that high activity in both is associated with a bias toward choosing immediate rewards.

The frontal and parietal cortexes are also involved in working memory - being able to hold data in mind over a short delay. When asked to choose between $18 now or $20 in a month, the subjects had to calculate how much that $18 (or what it could buy now) would be worth in a month and then compare it to $20 and decide whether it would be worth the wait.

The parietal cortex and the dorsal prefrontal cortex were much more active in people unwilling to wait. This could mean, Boettiger said, that the area is working less efficiently in those people.

The researchers also focused on a variant of a gene called COMT. The mutation is associated with lower dopamine levels, and the study showed that people with two copies of this allele (resulting in the lowest dopamine levels) had significantly higher frontal and parietal activity and chose "now" over "later" significantly more often.

"We have a lot to learn," Boettiger said. "But the data takes a significant step toward being able to identify subtypes of alcoholics, which could help tailor treatments, and may provide earlier intervention for people who are at risk for developing addictions."

The bigger picture, she added, is that her study provides more evidence that addiction is a disease, something even some of her peers don't yet believe.

"It's not unlike chronic diseases, such as diabetes," she said. "There are underlying genetic and other biological factors, but the disease is triggered by the choices people make."

"It wasn't that long ago that we believed schizophrenia was caused by bad mothers and depression wasn't a disease. Hopefully, in 10 years, we'll look back and it will seem silly that we didn't think addiction was a disease, too."

source: http://www.ucsf.edu/

Can a drug cure an addict?

Researchers are working on a vaccine that could neuter the effects of narcotics like cocaine. Some experts warn this magic bullet could backfire

A man is at a downtown loft party. He knows he shouldn't be there, but a friend convinced him it would be a good time, one not to miss.

The music, the short skirts and familiar faces set off an urge he has been fighting for six months. It's been that long since he last cut cocaine. And he swore to stay clean.

But tonight, the pull is too strong. In a bathroom, after a quick exchange, he gets his fix.

He waits a few minutes. Yet the euphoria does not come. The vaccine worked – it stopped the cocaine molecules swirling in his blood from reaching his brain – and the man, even after giving in to temptation, does not spiral back into addiction.

The man in this scenario does not exist. But in as few as five years, this experience could be very real for the hundreds of thousands of people in North America who struggle with cocaine addiction.

In an ever-widening search to treat addiction, scientists have homed in on vaccines as a way to help people kick their habits for good. They say the powerful technology holds promise as an innovative way to treat drugs of abuse, including cocaine, methamphetamine, and even nicotine.

Human trials for the nicotine and cocaine vaccines are already well under way and have yielded good results. The National Institute for Drug Abuse in the U.S. has put $15 million toward research.

The promise of a magic bullet, a quick fix that would tear people away from drug dependency, is enticing to researchers, clinicians and addicts alike. But even as the technology is being perfected in laboratories, experts doubt that a single type of treatment will be able to solve addiction, a complex puzzle that affects dozens of brain processes and arises from myriad environmental, economic and social situations.

Anti-addiction vaccines also come with a host of ethical dilemmas: Should parents be allowed to inoculate their children against cocaine and nicotine?

Should convicted drug offenders have to be vaccinated against their illegal habit before entering prison? Should a vaccine be forced upon people, whether a person with mental illness or a pregnant mother, to protect their health?

Despite these concerns, proponents say vaccines, if and when they are shown to be safe and effective, will hold an important niche in addiction treatment and therapy.

There needs to be a wide variety of options since people respond differently to different treatments, says Margaret Haney, an associate professor of clinical neuroscience at Columbia University who studies medications, including a vaccine, to treat cocaine dependence.

Right now, she says, there are not enough medications available to treat most types of drugs of abuse, particularly cocaine.

"A vaccine is not going to cure cocaine addiction," she says.

"But there is a subset of people who will benefit from this approach ... There is a great call out there among people who are dependent, and from their family members, for something to help."

Anti-addiction vaccines employ immunotherapy and work by setting the body's immune system against drug molecules floating in the blood.

Normally, cocaine and nicotine molecules are too small for the body to recognize and easily pass from the bloodstream into the brain, where they set off pleasure receptors and produce a high.

To create a vaccine, scientists pair drug molecules with proteins to increase their overall size.

This forces the body to recognize them and to start producing antibodies against them.

After several inoculations, a patient who tries to use drugs will have enough antibodies in their blood to fight the new drug molecules, which are then prevented from reaching the brain.

The antibodies are excreted with no lasting effects.

Since vaccines target drugs before they reach the brain, scientists predict patients should experience fewer side effects.

Most other medications used to treat addiction work by changing neural pathways in the brain that mediate the effects of a particular drug.

At Columbia, in 2003, Haney tested a cocaine vaccine on 10 people who had no plans to quit using the drug.

After a course of four vaccines injected over a 12-week period, half of the people produced sufficient levels of cocaine antibodies and reported a substantial decrease, up to a 70 per cent drop, in their dependence.

Haney says the results are exciting.

One of the concerns with a cocaine vaccine is that once inoculated against a cocaine high, determined users will seek other drugs. But Haney's subjects did not do that.

"On the outside, they were using less cocaine. They just stopped. None of them switched to another drug of abuse."

A 2005 Yale University clinical trial of 18 cocaine addicts in early treatment found that cocaine antibodies persisted in the blood six months after inoculation, and subjects reported the usual euphoric effect of cocaine had diminished.

Clinical trials of nicotine vaccines have also met with success and experts say one of these vaccines will likely hit the market in as little as three years.

A 2005 clinical trial out of the University of Minnesota looked at NicVAX, a vaccine produced by Nabi Biopharmaceuticals based in Boca Raton, Fla. It found 38 per cent of smokers who received a higher dose of the vaccine quit smoking for one month, compared with 9 per cent of the placebo group.

"This is proof of principle that this (vaccine) can help people quit smoking," says study author Dorothy Hatsukami, the Forster family professor in cancer prevention at the University of Minnesota.

She sees the vaccine as a tool to help determined quitters from relapsing.

"Nothing is going to be a miracle cure," she says.

"Cigarette smoking is about more than just the drug itself. It includes a lot of things, the social environment, the pleasure sensory of smoking, using it to deal with stress. There are a lot of factors associated with smoking that people still need to deal with ... It (quitting) will still be a struggle, but it's always good to have something to help with the struggle."

Scientists who are working on anti-addiction vaccines see both the promise and the challenges that lay ahead.

Before the nicotine or cocaine vaccines can get to market, scientists have to figure out how to make them more effective, says Paul Pentel, professor of medicine and pharmacology at the University of Minnesota and a pioneer in the field.

It is clear, he says, from the three nicotine and one cocaine clinical trials that the more antibodies a person can produce, the better their chance of not using the drug. The clinical trials have also shown that not everybody who gets the vaccine will produce enough antibodies. Scientists don't yet exactly know why this happens.

"It needs to be improved to be generally useful and to get the most out of it," says Pentel.

Experts also say the mounting excitement over anti-addiction vaccines has to be tempered. Many people think of vaccines as a cure-all. And in most cases that is true; a shot against, say, measles, will prevent the disease from striking.

But anti-addiction vaccines work more like medication, says Pentel. People will likely need multiple doses over many months or years. Vaccines won't curb cravings or deal with the underlying reasons for addiction. And, in their current form, they certainly will not stop people from seeking drugs in the first place.

Haney at Columbia is adamant that people are not vaccinated against their will.

"If parents want to vaccinate their kids, I feel very strongly that that will be a disaster," she says. "The only appropriate use is for somebody who is very motivated to quit."

Tony George, a professor and chair in addiction psychiatry at the University of Toronto, says anti-addiction vaccines will be used in treatment programs once they are proven to be safe and effective. Clinicians are always looking to have more tools to help clients stay clean for good.

"This will be a bonus to our armoury," he says. "It just increases our repertoire and our chances of success."

source: The Toronto Star
Megan Ogilvie
Health Reporter

Heavy drinking, conduct disorder linked to high-risk sexual behavior

Psychiatry researchers at Washington University School of Medicine in St. Louis have found that a clinical diagnosis of alcohol dependence in young adults is associated with having a high number of sex partners.

"Some participants in the study reported 50 or 100 partners, and research shows — and common sense tells you — that the more sex partners you have, the more likely you'll encounter someone with an STD," says first author Patricia Cavazos-Rehg, Ph.D., research instructor in the Department of Psychiatry. "Chances also increase for unintended pregnancies and other health complications."

The study, published in the December issue of the journal Alcoholism: Clinical & Experimental Research, also found links between a conduct disorder diagnosis and high numbers of sexual partners as well as between problem drinking and more partners. Of the three, however, alcohol dependence had the most influence on number of sex partners.

Alcohol dependence is an excessive use of alcohol that's harmful to physical and mental health. Some alcohol-dependent people drink every day. Others may drink only sporadically but consume large amounts of alcohol when they do drink. That sort of binge drinking is particularly common in adolescents and young adults, like those surveyed in this study. Problem drinkers, on the other hand, have many of the same symptoms, and may go on to become dependent, but they were not alcohol dependent when the study was conducted.

Conduct disorder is a disruptive disorder, like ADHD or oppositional defiant disorder. Its symptoms tend to include truancy from school, setting fires, getting into fights or being cruel to people or animals.

Of those in this study who were alcohol dependent, 45 percent reported having 10 or more sexual partners. In addition, 37 percent of those with a conduct disorder diagnosis had at least 10 partners.

Previous studies have linked heavy drinking and conduct disorder to high-risk sexual behavior. This study focused specifically on the number of partners, and it defines high risk using a larger number than typically seen in the psychiatric literature.

"To my knowledge, most research in young adults has used a standard of 'up to six' sex partners when examining risk," Cavazos-Rehg says. "But the average number of partners for the people in this study was 9.26, so instead of using 'six or more' partners as our standard for high risk, we increased that number to 10."

The researchers conducted personal interviews with 601 people between 18 and 25 years old. All were unmarried and related to alcohol-dependent individuals who participated in the national Collaborative Study on the Genetics of Alcoholism (COGA), an ongoing project involving interviews and DNA samples from more than 10,000 people. The COGA database includes individuals from inpatient and outpatient alcohol treatment centers and their families. Families in the COGA study usually have multiple members with alcohol dependence.

"We categorized these subjects according to three levels of alcohol involvement — non-dependent, problem drinking and alcohol dependent — and demonstrated how a stepwise increase from non-dependence to problematic alcohol use to alcohol dependence is associated with a higher number of sexual partners," says Cavazos-Rehg. "We found that 22 percent of the non-dependent people had 10 or more partners, compared to 31 percent of problem drinkers and 45 percent of those who were alcohol dependent. We also found a risk for a high number of sexual partners among those with conduct disorder, independent of their level of alcohol involvement. And those with both alcohol dependence and conduct disorder were at greatest risk of having a high number of sex partners."

Cavazos-Rehg suggests when young people are treated for alcohol problems — from inpatient treatment for alcohol dependence to emergency care following an alcohol-related car accident— it might be a good idea to screen them for STDs or HIV infection and to discuss safe sex practices. Personnel at STD clinics also might want to ask patients about their alcohol use and provide referrals to alcohol-related treatment centers.

"Perhaps clinicians can work together to treat both problems," she says. "A better understanding of alcohol dependence and conduct disorder could become part of a comprehensive strategy for reducing the transmission of STDs and unintended pregnancies."

source: Washington University