Drug And Alcohol Abuse Double Risk Of ICU Admission

While the personal health and safety risks of drug and alcohol abuse are well-documented, a new study by researchers at LDS Hospital and Brigham Young University suggests substance dependence increases medical costs by way of the intensive care unit.

Analysis of intensive care unit admissions at LDS Hospital in Salt Lake City shows drug and alcohol abuse make a patient twice as likely to be admitted to intensive care, according to the new study, published in the December issue of Intensive Care Medicine.

"Since these patients are admitted to an intensive care unit, which is geared to treat patients with a much higher acuity, medical costs are higher than for those admitted to a general ward in the hospital," reported Mary Suchyta, M.D., lead author and a physician at Intermountain Medical Center and LDS Hospital.

The researchers reviewed records for 742 patients admitted to LDS Hospital's intensive care unit over a one-year period. Nineteen percent of those patients had a history of drug and alcohol dependence prior to becoming critically ill. That's twice the rate of the population served by LDS Hospital.

"It appears that that patients with drug or alcohol dependence are at higher risk for intensive care unit admission compared to the general population, which would increase overall medical costs," said Ramona Hopkins, a psychology professor at BYU and researcher at Intermountain Medical Center and LDS Hospital.

Patients with drug or alcohol dependence were on average six years younger than the rest of ICU patients.

"What's alarming is that substance dependence meant that these individuals were critically ill and admitted to the ICU at a much younger age than the general population," Hopkins said. "If these individuals do not completely recover and return to work, that represents large potential societal costs."

The new study earned praise from the editors of Intensive Care Medicine, who noted that there are significant gaps in this type of knowledge in most ICU settings and while this article did not answer many of the questions posed by these gaps, it should stimulate further research and collaboration.

Both Drs. Suchyta and Hopkins agree that the detection of substance dependence earlier would allow doctors to address those issues and this may improve recovery.

"Dr. Hopkins and myself have thought for many years that patients with drug and alcohol dependence were over represented in the ICU populations that we have studied over the last 10-15 years and this study suggests that we were correct," noted Dr. Suchyta.

BYU undergrad Callie Beck is also a co-author on the new study. It's her second time publishing an academic paper alongside Hopkins. In 2006 she co-authored a study on brain imaging, a field she would like to pursue in graduate school. Beck is applying to nine graduate schools, including UCLA, Vanderbilt and the University of Maryland.

"Callie is an amazing student," Hopkins said. "She was involved in many aspects of the research, including data analysis and writing. That level of experience will make her stand out as she applies to graduate school."
___________
source: MediLexicon

One-in-four adults drinks excessively as doctors warn of 'tsunami of alcohol-related harm'

A quarter of UK adults are damaging their health through excessive drinking, it was revealed yesterday.

Some ten million regularly flout advice on how much to drink, egged on by a licensing industry ignoring its own voluntary code on social responsibility.

There is also clear evidence that cheaper booze is to blame for a massive rise in alcohol consumption, as drink prices have halved in 30 years, relative to earnings.

A blizzard of new figures included:

* The harm caused by excess drinking is costing the UK £25billion a year in healthcare, crime and lost productivity.
* Aound 800,000 hospital admissions a year are due to alcohol-related conditions, 70 per cent more than in 2002-2003.
* Heavy drinking is killing 15,000 people a year - including a quarter of all deaths among young men aged 16 to 24.

Ministers were accused of 'dithering' as they hinted they may bring in laws to replace the failed voluntary code and outlaw aggressive discounting, but said they
would wait for more evidence before making any decision.

Professor Ian Gilmore of the Royal College of Physicians warned: 'The Government are understandably anxious about being seen as a nanny state, but unless they take action their own figures suggest we are moving towards a tsunami of health-related harm.'

Alcohol industry leaders hit back, questioning the findings and accusing the Government of failing to enforce existing laws.

The Home Office commissioned consultants KPMG to assess the voluntary code, which was agreed three years ago and is supposed to stop drinks companies, pubs and bars cashing in on binge drinking.

In particular it is meant to stop the trade glamorising heavy drinking, marketing products to youngsters or encouraging rapid boozing through cutprice promotions in bars.

Another code is meant to ensure drinks containers are clearly labelled with the units of alcohol they contain.

The codes were at the heart of the Government's strategy as it brought in 24-hour drinking.

But researchers uncovered a catalogue of blatant abuses, describing scantily-clad women selling shots of spirits to drunken men in clubs by flirting with them, club DJs urging punters to drink more so they can 'get laid' and bar staff selling alcopops to young customers too drunk to count their change.

In 726 visits they saw only three cases where staff refused to serve a drunken customer. The worst excesses were in 'vertical drinking' venues - the large town centre pubs with no seats where young customers are crammed in.

Researchers also voiced concern over cheap supermarket alcohol.

KPMG concludes that the voluntary code has failed totally. It blames 'overriding commercial interests' to sell more alcohol, and the lack of enforcement. A separate study at Sheffield University highlighted close links between alcohol prices and consumption levels, while Department of Health figures detailed the level of harm.

The British Beer and Pub Association called for 'a renewed focus on individual responsibility and accountability, not just pointing the finger at business'.

A spokesman said: 'The Government should address the underlying culture. Legislation is a sledgehammer that will not crack the nut.'

The lost labelling

The drinks industry first agreed to include alcohol unit information on all bottles and cans ten years ago.

Labels should display the number of units inside and remind drinkers of the Government's 'safe' guidelines.

These are three to four units a day for men and two to three for women.

But a decade later, independent monitoring say they found that only just over half of all packaging - 57 per cent - contains such labelling.

Just 3 per cent carried all the information ministers want, including a warning to pregnant women to avoid alcohol.

The Department of Health admitted: 'There is now real doubt as to whether the agreement can be implemented to the extent that was originally expected'.

The 24-hour impact

The introduction of round-the-clock drinking almost three years ago was one of Labour's most controversial moves.

The Licensing Act swept away longstanding laws on closing times, letting thousands of pubs and clubs stay open into the early hours.

Police and hospitals have since complained of dramatic increases in their workload late into the night.

In the worst-affected areas, alcohol-related cases in hospital have more than doubled.

Public Health minister Dawn Primarolo played down the impact of the changes yesterday, insisting the upward trends in alcohol consumption and harm were already well established and there is no evidence they have become worse.

But hopes of creating a 'Mediterranean-style' cafe culture appear to have come to nothing.
__________________
source: Mail Online

Heavy drinking in youth tied to heart risks later

People who drink heavily in their youth may have a higher risk of developing a collection of risk factors for heart disease and stroke, new research suggests.

In a study that examined the lifetime drinking habits of more than 2,800 adults, researchers found that those who drank heavily in their teens and young adulthood were more likely to have metabolic syndrome than those who drank more moderately throughout adulthood.

Metabolic syndrome refers to a grouping of risk factors for heart disease, stroke and diabetes - including abdominal obesity, high blood pressure, low levels of 'good' HDL cholesterol, high blood sugar and high triglycerides, a type of blood fat. People who have three or more of these problems are considered to have metabolic syndrome.

While moderate drinking can be heart-healthy - helping to boost HDL levels, for example - excessive drinking is not. The new findings suggest that drinking heavily early in life might contribute to metabolic syndrome later on.

'There are already many reasons for encouraging young people to avoid heavy drinking,' Dr Marcia Russell, one of the researchers on the study, said.

'Long-term health consequences, such as an increased risk of cardiovascular disease, may be another,' added Dr Russell, a researcher at the Pacific Institute for Research and Evaluation in Berkeley, California.

She and her colleagues report their findings in the Journal of Clinical Endocrinology & Metabolism.

The study included 2,818 adults ages 35 to 80 who were questioned about their lifetime drinking habits and other lifestyle factors, like whether they exercised regularly or smoked.

All of the study participants had consumed alcohol regularly at some point in their lives, but Russell and her colleagues were able to identify two major lifetime 'trajectories' of drinking: in one, people started drinking early in life and tended to drink heavily in their teens and young adulthood, then tapered off by middle-age; in the second, 'stable' trajectory, people generally drank moderately over the years.

Compared with the stable group, the early drinkers were almost one-third more likely to have metabolic syndrome. In addition, their risk of being abdominally obese was 48 per cent higher, while their odds of having low HDL cholesterol were 62 percent higher.

Dr Russell said that to her knowledge, this is the first study to take the 'lifetime approach' to understanding the relationship between alcohol and health, and more research is needed to confirm the findings.

However, it is plausible that early, heavy drinking contributes to metabolic syndrome later on. She noted that excessive drinking causes oxidative stress in the body - a state that damages body cells over time and is thought to contribute to cardiovascular disease and other ills.

She also pointed out that alcohol contains 7 calories per gram, versus only 4 calories per gram of carbohydrate or protein. Those calories, coupled with the appetite-stimulating effect of alcohol, may help explain the link between early drinking and excess weight.

source: Reuters

New Study Reveals More Than 3 Million People Have Used Non-Prescription Cough And Cold Medicines To Get High At Least Once In Their Lifetimes

About 3.1 million people in the United States aged 12 to 25 (5.3 percent of this age group) have used over-the-counter (non-prescription) cough and cold medicines to get high at least once in their lifetimes, according to a report by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Newly analyzed data from the National Survey of Drug Use and Health (NSDUH) show the number is comparable to those who say they have used LSD (3.1 million), and is significantly greater than the number who reported having tried methamphetamines (2.4 million).

Overdosing on many cough and cold medications may result in serious life-threatening adverse reactions. Adverse reactions include blurred vision, loss of physical coordination, intense abdominal pain, vomiting, uncontrolled violent muscle spasms, irregular heartbeat, delirium and death.

The NSDUH survey also found that the number of 12- to-25-year-olds who reported misuse of non-prescription cough and cold medicines in the past year (1 million) exceeded the number claiming to have used methamphetamines (740,000) and LSD (485,000) in the past year. The number was somewhat lower than the number of young people reporting that they had used the drug Ecstasy (1.5 million) in the past year.

The survey, conducted by SAMHSA, is the largest of its kind and involves interviewing nearly 67,000 people from around the nation, including almost 45,000 persons aged 12 to 25.

Patterns of misuse of non-prescription drugs varied among demographic groups. Females aged 12 to 17 were more likely than their male counterparts to have misused these drugs within the past year (2.3 percent vs. 1.5 percent). But among those aged 18 to 25, more males had misused these drugs in the past year than females (1.8 percent vs. 1.3 percent). Among all persons aged 12 to 25, the rate of past year misuse among whites (2.1 percent) was three times higher than among blacks (0.6 percent) and significantly higher than among Hispanics (1.4 percent).

"While increasing attention has been paid to the public health risk of prescription drug abuse, we also need to be aware of the growing dangers of misuse of over-the-counter cough and cold medications, especially among young people," said SAMHSA Administrator Terry Cline, Ph.D. "The scope and danger posed by these medications requires a broad scale public health campaign - a campaign involving everyone, including the medical community, industry, parents and young people."

Although non-prescription cough and cold medications are generally safe when taken for medicinal purposes and as directed on their labeling, they can induce severe dissociative, "out-of-body" experiences when they are consumed in amounts far in excess of their recommended dosages. These reactions are similar to the effects of the well-known hallucinogens phencyclidine (PCP) and ketamine ("Special K").

SAMHSA is a public health agency within the Department of Health and Human Services. The agency is responsible for improving the accountability, capacity and effectiveness of the nation's substance abuse prevention, addictions treatment, and mental health services delivery system.

source: SAMHSA

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

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

Residential rehab places taken by Dutch addicts

Residential drug rehabilitation places at one of Scotland's leading addiction hospitals are being taken by Dutch heroin users because authorities in Scotland will not pay to use them, preferring to put addicts on methadone instead.

Peter McCann, chairman of Castle Craig Hospital in Peeblesshire, told The Observer that Scottish addicts were missing out on the best care available because of an obsession with meeting Holyrood methadone treatment targets, despite 'overwhelming' evidence showing that the drug is 'ineffective'.

McCann said that at the private Castle Craig hospital up to 30 beds for intensive detox and long-term care which should be available at any one time for home-based addicts - at a cost of £800 a week paid for by their health authorities - now go to patients from the Netherlands. With only 300 residential rehabilitation places available across Scotland, this represents 10 per cent of the total.

'The take-up for these places from authorities in Scotland is extremely poor and has been for a number of years now,' McCann said. 'We have an excellent reputation around Europe, and as a result we fill the beds with people from the Netherlands, where health authorities are happy to pay for the rehab here.'

A study by the Centre for Drugs Misuse at Glasgow University concluded that one in three heroin users who had residential treatment was drug-free after three years. But only 3 per cent of those who were just on methadone were clean after the same treatment period.

The head of the centre, Professor Neil McKeganey, said: 'Residential rehab is expensive, but where is the economic sense of providing a treatment that is ineffective. Methadone is cheaper - but it is not working.'

McCann traced the decline in uptake of places to the year 2000 and the establishment of the Alcohol and Drug Action Teams. These partnership organisations, which are paid for by local government, the NHS and the police, were set up to tackle the joint issues of alcohol and drug problems prevalent in Scottish society.

He said: 'Methadone has proven to be next to useless in terms of getting people off drugs, but it seems to satisfy their need to meet targets for care, and this would appear to be more important than whether they are useful or not.'

But Tom Wood, chairman of the Scottish Association of Alcohol and Drug Action Teams, argued: 'There is a lot of evidence in support of methadone - it reduces the amount of chaos in an addict's life and does help. However, it is a tourniquet which if left on too long can leave you with gangrene. We have to develop our other support services as well.Residential rehab is the Rolls-Royce treatment, and while it is good for some people it is not good for others. It is also very expensive - which is why we are investing in community-based care. Castle Craig is a fine institution, but it is also a private business and our budgets are finite.'

The anomaly at Castle Craig emerged close to the second anniversary of the death of two-year-old Derek Doran, who drank 50ml of his mother's methadone at their home in Elphinstone, East Lothian. This tragedy in December 2005 and other high-profile cases involving children spurred the then First Minister, Jack McConnell, to order a major review of the way Scotland deals with heroin users and led to a report critical of the lack of support given to those prescribed methadone.

But the study came down in favour of the methadone programme as the cheapest and most effective treatment available.

McKeganey said that 'nothing has changed' since Derek Doran's death, and there were thousands of children who remained at risk.

There are 51,582 known heroin users in Scotland. A third of these are believed to be caring for children under the age of 16.

Source: Thomas Quinn
Sunday December 2, 2007
The Observer

Bottoms up for British Columbia booze prices?

A health pitch for the government: the lower the alcohol content, the lower the price.

The legislature's finance committee unveils its recommendations this afternoon, and there was an intriguing flurry of last-minute activity to do with liquor pricing that makes one wonder.

The committee will be forwarding suggestions to Finance Minister Carole Taylor for next year's budget. The ideas come from hundreds of submissions from the public, including people who showed up at public hearings the MLAs held around B.C.

The deadline for submissions was in late October. But in the first week of November, two doctors popped up at the committee's last working session and got their own hearing.

One of them was the Provincial Medical Health Officer, Dr. Perry Kendall. He got the special invitation to appear based on his status and expertise.

And he brought with him Dr. Tim Stockwell, the director of the University of Victoria's Centre for Addictions Research, and a recognized expert in alcohol-related policy.

The pair made a fairly compelling pitch for a significant change in the way booze is taxed and priced in B.C.

It's in line with B.C. Liberal thinking on health policy and it could conceivably raise up to $88 million a year to deal with the addictions that underlie homelessness, street crime and other social problems.

Kendall said the concept could ease the burden on the health and justice systems, improve community safety and be a wellspring of revenue for prevention and treatment services.

Part of the idea is simply to price and tax wine, beer and spirits according to their alcohol content.

The lower the alcohol content, the lower the price. It's almost the reverse of the current pricing scheme, Stockwell said.

He published the proposal a year ago, based on what his native Australia has done with booze taxes. It's been circulating since then and has attracted enough attention that the politicians from both sides of the legislature were keen to hear about it first-hand.

"A fundamental suggestion is that tax rates should take account of the health, social and economic costs of the product," he told MLAs. "This is no ordinary product ... The main thrust of my point today is that the way alcohol is priced through the liquor stores actually gives more incentives for people to choose higher alcohol-content drinks than lower alcohol-content drinks."

Stockwell's analysis of B.C.'s liquor pricing is that the incentives "are all the wrong way around."

Beers with less than four-per-cent alcohol are relatively more expensive than more potent brands.

Pricing for coolers -- fruit drinks mixed with alcohol -- leans even heavier in favour of encouraging people to buy higher alcohol-content brands.

Stockwell said the change could be revenue-neutral, in the sense that the price relationship between beer, wine and spirits would be maintained.

It would amount to a difference of several dollars between a case of lower-alcohol beer and a higher-alcohol case. There'd be a similar difference in wine and spirits.

He said the centre is also releasing a study next month showing most people can't tell the difference between low and mid-strength beer. (They tested some UVic students with a pub night and found "they enjoyed themselves just as much with the 3.8 per cent as the 5.5 per cent.")

And people don't necessarily just drink more. Stockwell said it's hard to get drunk on low-alcohol beer, because people fill up too quickly.

The revenue projections stem from a related idea -- a flat five-cent-a-drink levy dedicated to harm reduction.

And both doctors stress there is a lot of harm that needs to be reduced. Absolute alcohol consumption per adult has increased continuously in the last six years. Kendall said there's been a "substantial increase" in hospitalizations for alcohol-related conditions.

Neither of them brought up one of the obvious reasons for the increase in consumption -- the proliferation of private liquor stores brought on by the Liberal policy. There are now 1,273 liquor stores in the province, hundreds more than a few years ago.

Said Stockwell: "We read in the papers every day about the seriousness of this problem and the lack of resources to deal with it."

A five-cent levy in Australia generally went over well with the public, he said.

"They hate alcohol prices going up, but if they see the funds going toward a useful function like more treatment ... that's usually supported."

It would encourage local production of more low-alcohol drinks, reduce alcohol-related deaths and injuries and be accepted by the public, he said.

There's no telling whether the concept will make it into the report being released today. And even if it does, it still has to go to the finance minister for consideration before it makes it into next February's budget.

author: Les Leyne

© Times Colonist (Victoria) 2007

Iowa's drinking called epidemic

It has been more than 12 years since the death of University of Iowa student Matthew Garofalo, and it's likely that few, if any, students on campus even know who he was or how he died.

On Sept. 7, 1995, Garofalo, 19, of Elgin, Ill., passed out drunk about 11 p.m. at the Lambda Chi Alpha fraternity house, where he was a pledge. It wasn't for another 12 and a half hours that Garofalo's lifeless body was found. In the hours between, Garofalo had vomited while on his back and inhaled some of his vomit. His lungs became irritated and filled with fluid until they stopped producing oxygen. About 7 a.m. his heart stopped, and he died.

Although this may be the most extreme example of the effects of binge drinking, health professionals warn that the culture of excessive drinking in Iowa City and at UI is creating problems for students right now that will continue for the rest of their lives.

They point to Garofalo's death, the death of 20-year-old Joseph Domke -- who fell from a balcony after drinking downtown underage -- drunken driving deaths, countless drunken assaults and attacks and a 2005 Harvard School of Public Health study that states UI has a binge drinking rate of nearly 70 percent -- the highest in the Big Ten -- as reasons for their concern.

Binge drinking is defined as five or more consecutive drinks in a sitting in a two-week period for men and four or more for women.

Harvard's statistics also show that although the percentages of occasional binge drinkers have declined since the study began in 1993; the percentage of frequent binge drinkers has increased.

UI students rate much higher than college students on average, where only two of five students nation wide report binge drinking.

It's for all of those reasons and the adverse health and societal effects of binge drinking that medical professionals and many others are in support of the proposed 21-only ordinance, which would ban 19- and 20-year-olds from bars. Proponents of the legal age measure argue that by restricting access to alcohol, the binge-drinking rate would significantly drop.

Will binge drinking decrease?

However, opponents argue such a measure would not decrease binging and simply would push underage people out into the communities and into unsupervised and potentially dangerous house parties.

Atul Nakhasi, a UI junior who founded the anti-21 group, the Student Health Initiative Task Force, said the proposed ordinance "directly impacts student health and safety," by potentially driving underage students to house parties.

"We're going to end up seeing more underage drinking," said Nakhasi, a pre-medicine student. "Now instead of using ID checks, you could have middle schoolers at the party. Instead of serving checkers (who can control the number of drinks served), you're going to have students with greater underage drinking. And what we're going to see is a likely increase in DUIs (and) sexual assaults."

Richard Dobyns, a clinic professor of family medicine at the UI, said it's difficult to speculate whether or not there would be more house parties.

"Could there be? Sure. You can speculate in either direction," Dobyns said. "There's always been house parties, there's always been pre- and post-drinking. Basically, what this initiative will instigate, not by itself, is a reduced alcohol consumption culture."

Dobyns said he believes the drinking rate among students has reached epidemic proportions. That belief has caused Dobyns to take action and act as a spearhead for the 21-only proposal.

"I mean, if you saw that the state of Iowa had twice the influenza numbers of any other state, you would hope your community would do something about it," he said. "You need to respond. It's not ethical to walk away from something like that."

Dobyns said he has a broad definition of the health effects of binge drinking and although students' binge drinking doesn't do much immediately, there are consequences later on. People who develop alcohol-related issues are more likely to have difficulty forming meaningful relationships and experience trouble holding down a job, as well as an increased likelihood of developing mood disorders, unwanted pregnancies, unwanted sexually-transmitted diseases, premature coronary disease, liver disease, vascular disease and neurological disease.

"If you define health a little more broadly, you would include those things as well," Dobyns said.

Dobyns added that public policy should not be based on random events, such as Garofalo's death.

"It's extremely sad for everyone," he said. "However, you have to look past those sad issues and look at the everyday sad issues."

Effects: now and later

Dr. Peter Nathan, a professor emeritus in community and behavioral health, was acting UI president at the time of Garofalo's death. He said it was hard to predict whether Garofalo's death would have been prevented by a 21-only measure.

"Would this have happened to Matthew if the referendum happened at the time?" Nathan said. "Matthew didn't drink in the bars."

Like Dobyns, Nathan -- an alcoholism researcher for 40 years --said binge drinking at a young age doesn't immediately do much to students, health-wise. However, he said frequent binge drinking can lead to cutting classes, less studying, an increased risk for injury, forgetting things or doing regrettable things.

The long-term effects are more severe, Nathan said. Frequent binge drinkers -- which represent about 46 percent of the student body -- are at a much greater risk to develop alcoholism after college.

"Alcoholism, in turn, is associated with a lot of sociological, psychological and physical problems," he said. "Alcoholics, on average, die several years early."

That's not to say Iowa City is inundated with alcoholic graduates from the university. Nathan said well-educated communities like Iowa City tend to have fewer alcoholics than other places.

Nathan said out of each graduating class, there could be up to 5 to 10 percent of the students who meet the criteria for alcohol dependence. Many of them don't stick around Iowa City, though.

"Students who graduated from here do a whole lot of things," Nathan said. "Some stay here, many don't."

Nathan said if parents are worried about sending their kids to the UI and having them come home with alcohol abuse problems, their concerns are valid, although coming to the university does not doom students to a life of alcoholism.

"The damage is still there"

However, centers that treat people for substance abuse problems, such as MECCA, are seeing people in their late teens and early 20s. Steve Steine, the clinical coordinator for MECCA's Iowa City location, said students are coming to the facility for outpatient programs.

"Most of the college students that we are seeing are those that have had a first or second OWI offense," Steine said. "Or, they may have what we would call recurrent alcohol-related issues; two or more public intoxications, two or more PAULAs, that really would have them meeting the criteria."

Steine said the facility doesn't track whether or not their patients are students, but of the 24 people enrolled in the current outpatient program -- an entry level program aimed at younger people and those experiencing first time substance abuse problems -- there are 10 people 21 or younger. He did not know whether or not they were university students.

"It's difficult to track," Steine said.

Steine didn't wish to weigh in on his view of the ordinance but said the problems with alcohol consumption might not be solved by laws and fines.

"If students get charged with a PAULA in a bar, they usually just get a ticket, pay a fine, that's it," he said. "They don't get any attention until there's something recurrent. I've known some students who have had multiple possession tickets and aren't mandated to doing some substance abuse program."

Ed Haycraft, an abuse counselor for UI Student Health, said the health center already is treating students for secondary effects of alcohol abuse. In 2006, 600 to 700 students came to Student Health for alcohol-related issues. Haycraft said they either attended the Seminar on Substances, an educational program, or the Brief Alcohol Screening and Intervention for College Students (BASICS) program.

"There's quite a few young people that come in and say, 'Well, I'm depressed,' and we ask them, 'How much are you drinking?' " Haycraft said.

Haycraft said drinking releases dopamine -- a chemical that triggers a pleasurable feeling -- into the brain. When the drinking stops and the production of dopamine halts, drinkers come down from that high and feel depressed.

However, in terms of physical effects, outside of getting sick or falling and hurting themselves when they're drunk, Haycraft said binging won't do much to younger drinkers.

"When you are 18 to 20 years old, you snap back real quick," Haycraft said. "But the damage is still there. It's one of those things that people don't realize when they're 18 to 20."

But some damage is being done right now. According to an annual report compiled by Student Health, of the 875 surveys completed, 73 percent reported they had experienced hangovers from drinking, 52 percent said they had vomited, 32 percent said they had injured themselves while drinking and 29 percent said they had unintended or regretted sex.

Students like Nakhasi, UI Student Government President Barrett Anderson and many others said they don't refute the negative health effects of binge drinking, just the approach taken by the 21-only measure.

"This is not going to fix these issues of underage drinking," Nakhasi said. "We recognize there's a problem...Our goal is not to only address and oppose this measure, but propose a possible solution."

Still, Ralph Wilmoth, the outgoing director of Johnson County Public Health, a 21-only supporter, said something must be done.

"The whole idea that we have an environment that supports that behavior is a contradiction to the very principles that public health is based on," Wilmoth said.

source: Press Citizen

Family history of alcoholism affects response to drug used to treat heavy drinking

New study in Biological Psychiatry

Philadelphia, PA, September 19, 2007 – Naltrexone is one of four oral medications approved by the U.S. Food and Drug Administration (FDA) for the treatment of alcoholism. A recent large multicenter research study of alcohol dependence supported by the National Institute of Alcoholism and Alcohol Abuse (NIAAA), the COMBINE Study, suggested that naltrexone produced a modest but significant benefit but another FDA-approved medication, acamprosate, was ineffective. Perhaps consistent with its modest effects in COMBINE, naltrexone is not widely prescribed in the treatment of alcoholism. Yet, clinicians report that naltrexone may have significant benefits for individual patients. To make naltrexone a more useful medication, it would be important to begin to identify groups of patients who might be more or less likely to show a significant clinical benefit from naltrexone prescription and to understand the causes of differential naltrexone efficacy. A new study that will appear in the September 15th issue of Biological Psychiatry suggests that alcohol dependent individuals with a family history of alcohol dependence may be more likely than alcohol dependent individuals without a family history of alcohol dependence to reduce their drinking in the laboratory when prescribed naltrexone.

Krishnan-Sarin and colleagues at the NIAAA Center for the Translational Neuroscience of Alcoholism studied alcohol consumption in the laboratory by alcohol-dependent individuals who were not seeking treatment. The participants were studied in the laboratory after 6 days of treatment with 0 mg (placebo), 50 mg, or 100 mg of naltrexone. The authors discovered that naltrexone decreased drinking in those with a family history of alcoholism and this effect was greatest with the highest naltrexone dose. However, it increased drinking in those without a family history of alcoholism and this effect was greatest at the highest naltrexone dose.

John H. Krystal, M.D., one of the authors, notes that “When studied in large groups, naltrexone appears to have a rather small effect upon the ability to reduce drinking or remain abstinent from alcohol. However, there is growing evidence that there are subgroups of patients who show substantial benefit from naltrexone, even when naltrexone fails to work in the overall trial (see Gueorguieva R et al. Biol Psychiatry. 2007 Jun 1;61(11):1290-5).” According to Suchitra Krishnan-Sarin, Ph.D., the lead author, “The results suggest that family history of alcoholism may be an important predictor of clinical response to naltrexone and could potentially be used to guide clinical practice.” Dr. Krystal agrees, “These data suggest that family history might influence the optimal dosing of naltrexone and the nature of the clinical response.” Their hope is that these findings ultimately can contribute to a better treatment experience for some who are seeking to end their battle with alcohol.

________

Notes to Editors:

This article is “Family History of Alcoholism Influences Naltrexone-Induced Reduction in Alcohol Drinking” by Suchitra Krishnan-Sarin, John H. Krystal, Julia Shi, Brian Pittman and Stephanie S. O'Malley. All authors are affiliated with the Department of Psychiatry at Yale University School of Medicine in New Haven, Connecticut. Dr. Krystal is also affiliated with the VA Connecticut Healthcare System in West Haven, Connecticut and he serves as the Editor of Biological Psychiatry. This article appears in Biological Psychiatry, Volume 62, Issue 6 (September 15, 2007), published by Elsevier.

The other referenced article is R. Gueorguieva, R. Wu, B. Pittman, J. Cramer, R.A. Rosenheck, S.S. O’Malley and J.H. Krystal. New Insights into the Efficacy of Naltrexone Based on Trajectory-Based Reanalyses of Two Negative Clinical Trials. Biol Psychiatry. 2007 Jun 1;61(11):1290-5.

Full text of the article mentioned above is available upon request. Contact Jayne M. Dawkins at (215) 239-3674 or ja.dawkins@elsevier.com to obtain a copy or to schedule an interview.

About Biological Psychiatry

This international rapid-publication journal is the official journal of the Society of Biological Psychiatry. It covers a broad range of topics in psychiatric neuroscience and therapeutics. Both basic and clinical contributions are encouraged from all disciplines and research areas relevant to the pathophysiology and treatment of major neuropsychiatric disorders. Full-length and Brief Reports of novel results, Commentaries, Case Studies of unusual significance, and Correspondence and Comments judged to be of high impact to the field are published, particularly those addressing genetic and environmental risk factors, neural circuitry and neurochemistry, and important new therapeutic approaches. Concise Reviews and Editorials that focus on topics of current research and interest are also published rapidly.

Biological Psychiatry (www.sobp.org/journal) is ranked 4th out of the 95 Psychiatry titles and 16th out of 199 Neurosciences titles on the 2006 ISI Journal Citations Reports® published by Thomson Scientific.a

NIH Wins Two Emmy Awards For The Addiction Project

Two Institutes at the National Institutes of Health (NIH) have been honored with the prestigious Governors Award by the Academy of Television Arts and Sciences for their work with HBO on the Addiction Project. "Addiction" is a 14-part documentary television series and multimedia initiative revealing the science of addiction, its treatment, recovery, and its costs to families and society. A diverse group of people who were battling alcohol or drug addiction were featured, as well as addiction experts from around the country.

The celebrated Governors Award is the Television Academy's highest honor and is given to individuals or organizations committed to important social causes. HBO developed the series, which includes the documentary, independent films, and a Website, in partnership with the National Institute on Drug Abuse (NIDA), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the Robert Wood Johnson Foundation.

"This honor reflects our commitment to effectively communicate research results to the public," said NIH Director Elias Zerhouni, M.D. "The multimedia nature of this project gave us the opportunity to reach out to millions of Americans with a message of hope." HBO worked closely with NIH scientists to ensure the scientific accuracy of the documentary.

More than 13 million people saw the documentary when it aired in March 2007. Millions more have seen it through HBO, DVDs sold in bookstores and online, podcasts, Web streams, a companion book, local and national outreach parties and screenings, and prominent local and national media coverage. Much of the outreach was coordinated by addiction and recovery advocacy groups, including Community Anti-Drug Coalitions of America, Join Together, and Faces and Voices of Recovery, with support from the Robert Wood Johnson Foundation.

The award was presented during the September 8th Creative Arts Emmy ceremony at the Shrine Auditorium in Los Angeles. In acceptance remarks, NIDA Director Dr. Nora Volkow said, "I want to thank the Academy for its recognition, and HBO for its vision in developing this project, which has allowed us to reach millions with our message-that addiction is a chronic, relapsing brain disease. It does not care if you are rich or poor, famous or unknown, a man or woman, or even a child. If science-based treatment principles are followed, addiction treatment can work, and people can reclaim their lives." Dr. Volkow was featured prominently in the documentary, as was Dr. Mark Willenbring, NIAAA's director of the Division of Treatment and Recovery Research, and NIH grantees from across the country.

Currently, addiction affects 23.2 million Americans-of whom only about 10 percent are receiving the treatment they need. "HBO's Addiction Project afforded us the opportunity to directly acquaint viewers with available evidence-based medical and behavioral treatments," said NIAAA Director Dr. Ting-Kai Li. "This is especially important for disorders that for many years were treated outside the medical mainstream."

Each Institute has received an Emmy statuette. The Creative Arts Emmy ceremony will be televised on the E! Network on Saturday September 15th at 8:00 p.m. EST/PST. The centerpiece documentary can still be seen on HBO's Web site, http://www.hbo.com/addiction/ , where the DVD and book are also available.

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 http://www.drugabuse.gov.

The National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health, is the primary U.S. agency for conducting and supporting research on the causes, consequences, prevention, and treatment of alcohol abuse, alcoholism, and alcohol problems and disseminates research findings to general, professional, and academic audiences. Additional alcohol research information and publications are available at http://www.niaaa.nih.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 http://www.nih.gov.
source: Medical News Today

The Top Ten Reasons Marijuana Should Be Legal

Top ten reasons to do so, according to High Times.

10. Prohibition has failed to control the use and domestic production of marijuana. The government has tried to use criminal penalties to prevent marijuana use for over 75 years and yet: marijuana is now used by over 25 million people annually, cannabis is currently the largest cash crop in the United States, and marijuana is grown all over the planet. Claims that marijuana prohibition is a successful policy are ludicrous and unsupported by the facts, and the idea that marijuana will soon be eliminated from America and the rest of the world is a ridiculous fantasy.

9. Arrests for marijuana possession disproportionately affect blacks and Hispanics and reinforce the perception that law enforcement is biased and prejudiced against minorities. African-Americans account for approximately 13% of the population of the United States and about 13.5% of annual marijuana users, however, blacks also account for 26% of all marijuana arrests. Recent studies have demonstrated that blacks and Hispanics account for the majority of marijuana possession arrests in New York City, primarily for smoking marijuana in public view. Law enforcement has failed to demonstrate that marijuana laws can be enforced fairly without regard to race; far too often minorities are arrested for marijuana use while white/non-Hispanic Americans face a much lower risk of arrest.

8. A regulated, legal market in marijuana would reduce marijuana sales and use among teenagers, as well as reduce their exposure to other drugs in the illegal market. The illegality of marijuana makes it more valuable than if it were legal, providing opportunities for teenagers to make easy money selling it to their friends. If the excessive profits for marijuana sales were ended through legalization there would be less incentive for teens to sell it to one another. Teenage use of alcohol and tobacco remain serious public health problems even though those drugs are legal for adults, however, the availability of alcohol and tobacco is not made even more widespread by providing kids with economic incentives to sell either one to their friends and peers.

7. Legalized marijuana would reduce the flow of money from the American economy to international criminal gangs. Marijuana's illegality makes foreign cultivation and smuggling to the United States extremely profitable, sending billions of dollars overseas in an underground economy while diverting funds from productive economic development.

6. Marijuana's legalization would simplify the development of hemp as a valuable and diverse agricultural crop in the United States, including its development as a new bio-fuel to reduce carbon emissions. Canada and European countries have managed to support legal hemp cultivation without legalizing marijuana, but in the United States opposition to legal marijuana remains the biggest obstacle to development of industrial hemp as a valuable agricultural commodity. As US energy policy continues to embrace and promote the development of bio-fuels as an alternative to oil dependency and a way to reduce carbon emissions, it is all the more important to develop industrial hemp as a bio-fuel source - especially since use of hemp stalks as a fuel source will not increase demand and prices for food, such as corn. Legalization of marijuana will greatly simplify the regulatory burden on prospective hemp cultivation in the United States.

5. Prohibition is based on lies and disinformation. Justification of marijuana's illegality increasingly requires distortions and selective uses of the scientific record, causing harm to the credibility of teachers, law enforcement officials, and scientists throughout the country. The dangers of marijuana use have been exaggerated for almost a century and the modern scientific record does not support the reefer madness predictions of the past and present. Many claims of marijuana's danger are based on old 20th century prejudices that originated in a time when science was uncertain how marijuana produced its characteristic effects. Since the cannabinoid receptor system was discovered in the late 1980s these hysterical concerns about marijuana's dangerousness have not been confirmed with modern research. Everyone agrees that marijuana, or any other drug use such as alcohol or tobacco use, is not for children. Nonetheless, adults have demonstrated over the last several decades that marijuana can be used moderately without harmful impacts to the individual or society.

4. Marijuana is not a lethal drug and is safer than alcohol. It is established scientific fact that marijuana is not toxic to humans; marijuana overdoses are nearly impossible, and marijuana is not nearly as addictive as alcohol or tobacco. It is unfair and unjust to treat marijuana users more harshly under the law than the users of alcohol or tobacco.

3. Marijuana is too expensive for our justice system and should instead be taxed to support beneficial government programs. Law enforcement has more important responsibilities than arresting 750,000 individuals a year for marijuana possession, especially given the additional justice costs of disposing of each of these cases. Marijuana arrests make justice more expensive and less efficient in the United States, wasting jail space, clogging up court systems, and diverting time of police, attorneys, judges, and corrections officials away from violent crime, the sexual abuse of children, and terrorism. Furthermore, taxation of marijuana can provide needed and generous funding of many important criminal justice and social programs.

2. Marijuana use has positive attributes, such as its medical value and use as a recreational drug with relatively mild side effects. Many people use marijuana because they have made an informed decision that it is good for them, especially Americans suffering from a variety of serious ailments. Marijuana provides relief from pain, nausea, spasticity, and other symptoms for many individuals who have not been treated successfully with conventional medications. Many American adults prefer marijuana to the use of alcohol as a mild and moderate way to relax. Americans use marijuana because they choose to, and one of the reasons for that choice is their personal observation that the drug has a relatively low dependence liability and easy-to-manage side effects. Most marijuana users develop tolerance to many of marijuana's side effects, and those who do not, choose to stop using the drug. Marijuana use is the result of informed consent in which individuals have decided that the benefits of use outweigh the risks, especially since, for most Americans, the greatest risk of using marijuana is the relatively low risk of arrest.

1. Marijuana users are determined to stand up to the injustice of marijuana probation and accomplish legalization, no matter how long or what it takes to succeed. Despite the threat of arrests and a variety of other punishments and sanctions marijuana users have persisted in their support for legalization for over a generation. They refuse to give up their long quest for justice because they believe in the fundamental values of American society. Prohibition has failed to silence marijuana users despite its best attempts over the last generation. The issue of marijuana's legalization is a persistent issue that, like marijuana, will simply not go away. Marijuana will be legalized because marijuana users will continue to fight for it until they succeed.

Experts say addiction to video games is real

Parke Dieckmeyer's addiction began his freshman year of college. To feed his habit, he found himself skipping classes and staying up all night isolated in his dorm room.

Things got so bad that during finals week, he asked his resident assistant to lock up the source of his addiction so he'd be forced to study. It wasn't alcohol or a crack pipe that had to be hidden away. It was Dieckmeyer's computer.

He was addicted to video games. “I would even have dreams of being in the game,” he said. “It invades your mind.”

Fostering obsessive behavior

Addiction to video games, particularly the online interactive variety, is a growing phenomenon that affects people of all ages and professions.

Though not officially recognized as a medical condition, game addiction has fostered a tidal wave of anecdotal evidence about people who shun families and careers to devote huge chunks of their lives to games. More academic evidence is cropping up, as well as clinical treatment programs.

Dieckmeyer, now a 25-year-old Web developer, would spend six, eight or even more hours per day playing. Starting out with first-person “shooter” games like Counter-Strike, by his senior year he'd moved on to World of Warcraft, an MMORPG — massive multi-player online role-playing game.

In these games, players create characters they control in a virtually limitless world where they team up and interact with other players. Often set against a sword-and-sorcery or science fiction backdrop, MMORPGs have no traditional ending. Players strive for months or years to make their character more powerful and vanquish mighty foes, only to see expansions of the game broaden the horizon ever further.

It's the very open-ended nature of these games that makes them so appealing and, critics say, likely to foster obsessive behavior.

“The game manufacturers, especially in WoW, have built the game to make people put in time,” said Dieckmeyer. “If you're not putting in hours and hours and hours, you're not going to enjoy the game as much as people who do put in the time.”

Dieckmeyer continued playing after graduation, even after getting a job and marrying his high-school girlfriend, Christina. At one point, he realized he was spending a quarter of his waking hours playing World of Warcraft. He tried quitting, but soon resumed.

Christina said her husband's constant gaming was a source of contention. She was annoyed that their socializing had to be scheduled around his gaming. They fought about it occasionally, and she teased him about buying one of the “Warcraft Widow” T-shirts readily available on the Web.

Then Christina found out she was having a baby.

“Once I got pregnant, I joked with him, ‘You've got nine months to play the game, and then it's time to stop.' I guess I pressured him a little bit, but he made the decision mostly on his own,” she said.

“Granted,” she added, “he waited till the very last minute until the baby was here.”

Brynn Dieckmeyer was born five months ago, a few days after her dad gave up World of Warcraft. Though he never sought treatment, Dieckmeyer looked at models of alcohol addiction and decided he had a problem.

“I quit the game because I had a child. I could see it impacting my life in a negative way. It would take away from my lifestyle and family,” he said.

The decision to stop playing can be a watershed moment in gamers' lives — evidenced by the hundreds of videos posted on YouTube by people quitting MMORPGs. Often set to hauntingly beautiful music as players delete their characters, they are digital diaries filled with lamentation for the time spent in-game, as well as boastfulness about their virtual accomplishments.

Dieckmeyer says he'll avoid MMORPGs from now on. He still plays video games but limits himself to console gaming like Xbox 360 and Nintendo Wii, where the games tend to be more action-oriented and have definitive conclusions.

He admits the temptation is still there, especially when he talks with friends, most of whom still play World of Warcraft. It's not unlike, he said, an alcoholic on the wagon hanging out with his drinking buddies, nursing a ginger ale while eyeing their gin-and-tonics.

Almost like alcohol addiction

Liz Woolley believes the alcohol comparison is appropriate. Active in Alcoholics Anonymous as a recovering alcoholic, she built her Web forum for gaming addicts, On-Line Gamers Anonymous, using the same basic tenants and 12-step recovery program as AA.

Woolley, of Harrisburg, Pa., squarely places the blame for game addiction on the companies that manufacture MMORPGs. Because most of these games require a monthly subscription fee — generally about $15 — on top of the purchase price, they can be hugely profitable.

“Those new games, they're virtual worlds. They were created by the gaming companies to be addictive. They have staffs of people with degrees in psychology to make them as addicting as possible,” Woolley says. “People do get hooked in, and they get their mind taken over.”

Woolley says her son, Shawn, started playing Everquest, an early breakout MMORPG, at age 20 and soon became withdrawn, sullen and resentful of any urging to quit. Within three months of buying the game, Shawn had lost his job and been evicted from his apartment.

In November 2001, Shawn fatally shot himself while sitting at his computer. Liz found him dead on Thanksgiving Day. The game was still running. “That was his little message,” Woolley says.

She said Shawn had been playing regular video games for a decade and never had a problem with them like he did with MMORPGs.

Coleen Moore, coordinator of resource development at the Illinois Institute for Addiction Recovery in Peoria, Ill., says the interactive nature of these games is a huge draw, to the point that gamers eschew real-life relationships for virtual ones. MMORPGs allow someone struggling to establish a career or interpersonal relationships to take on the role of a dwarf warrior or undead sorcerer who's revered by other players.

“That's the high that allows them to kind of create their own persona, and be the person they maybe want to be, or the fantasy that they have about what they want in their life,” Moore says.

Bob Appelman, who studies game design at Indiana University, cited a student survey done last fall of heavy Warcraft players. Rather than experiencing isolation, many reported feeling enriched by the esteem they gained from other players.

“They felt empowered, whereas in the real world they were just followers,” Appelman says.

Moore's institute began treating Internet addiction in 1996, and in recent years has seen a spike in gaming problems. The game most cited is World of Warcraft, likely due to its popularity — more than 8.5 million players worldwide.

Officials at Blizzard Entertainment, which manufactures World of Warcraft, did not respond to requests for comment. But the company has highlighted its incorporation of parental controls that allows parents to schedule when and how long children can play.

In June, the American Medical Association rejected a proposal to recognize video game addiction as a psychiatric condition on par with alcohol or drug abuse.

But President Ronald Davis called for more study of the problem, and told the Associated Press that the AMA “remains concerned about the behavioral, health and societal effects of video game and Internet overuse.”

Durwin Talon, an associate professor who teaches video game design at IUPUI, tells his students to seek a balance where people really want to play their games, but without an obsessive need to do it all the time.

“The philosophy ... is that you should have a ‘back door' for people who play your games to hit ‘Save' and have their lives back,” Talon says. “You never want them to get into a situation where they're constantly playing these games, and they don't feel like they can leave.”

source: Gannett News Service

author: Christopher Lloyd

Alcoholism And Bad Neighborhoods: A Two-way Street

Living in neighborhoods characterized by unemployment, poverty, poor family integration and high residential mobility is known to contribute to a greater risk for alcohol problems. New research, the first of its kind, has found that the reverse relationship is also true: alcoholism has a negative effect on where someone lives.

"Most studies have looked at the effects of neighborhood characteristics on alcohol use, and only a few have looked at alcohol dependence," said Anne Buu, research investigator of psychiatry at the University of Michigan and corresponding author. "None have looked at these effects over a time span as long as 12 years; most cover only a one- or two-year time span. In addition, we looked at these relationships bidirectionally, that is, the effects of alcohol dependence on place of residence, and the long-term effects of neighborhood on alcohol dependence."

"This type of research is quite innovative and reflects a growing interest in 'macro-level' influences on alcohol-related outcomes," said Ryan Trim, research psychologist at the VA San Diego Healthcare System. "Unlike the extensive research on individual- and family-level risk factors, studies examining the link between alcohol use and neighborhoods have only gained momentum in recent years. Since a large proportion of the risk for alcoholism is environmental -- approximately 40 percent -- it will be increasingly important for researchers and clinicians to have a better understanding of neighborhood-level influences on alcohol use."

Researchers recruited 206 Caucasian men, with an average age of 33 years, through community and district court recruitment from a four-county-wide region. Alcohol-dependence diagnoses were established through semi-structured diagnostic interviews. Residential addresses were noted at baseline, and then at three-year intervals for a 12-year period. Census-tract variables were used to identify neighborhood characteristics.

Analysis indicates that alcoholism has long-term negative effects on place of residence, and vice versa. First, the more alcohol problems a man has, the more likely he is going to remain in -- or migrate into -- a disadvantaged neighborhood. Second, recovery from alcoholism is both protective against a downward social drift and favorable to improved social conditions. In addition, living in worse neighborhoods appears to have an adverse effect on alcoholic symptomatology over time.

In short, said Buu, the causal relationship between alcoholism and neighborhood social environment is a two-way instead of a one-way street. "Continuous alcohol involvement has long-term negative effects on place of residence," she said. "In contrast, recovery from alcoholism is protective against downward social drift."

Both Buu and Trim said that these findings have implications for women, even though they were not among the target study population.

"The effects may be even stronger on women because alcoholic women have a high tendency to marry alcoholic men, referred to as 'assortative mating,' said Buu. "Alcoholic involvement of both partners could speed up the downward social drift."

Buu noted that the study's findings show that the damaging effects of alcoholism are much broader than simple health consequences. "The effects also have a long-term impact on quality of life, including where one lives and their quality of life. Social environment appears to play some role in keeping the disorder going, and possibly even making it worse: we can see effects going from community to individual, and from individual to social environment. Preventive efforts therefore may also have effects in both directions."

Trim added that the results have both cautionary and optimistic applications for alcohol misuse. "The findings highlight the far-reaching impact of alcohol problems on the type of neighborhood an individual could reside in as an adult. Thus, high-risk adults who drift into lower-SES neighborhoods will likely face even greater challenges at recovery due to lack of resources and increased environmental stressors. However, adults who successfully treat their alcohol problems early in life are no more likely to experience this downward social drift than non-alcoholics. I would hope these findings provide additional incentive to any individuals who are unsure or unwilling to enter treatment for alcohol-related problems."

Results are published in the September issue of Alcoholism: Clinical & Experimental Research.

source: Science Daily.

European Tree Yields New Alcoholism Treatment

A drug approved last year for smoking cessation has also shown promise for use against alcoholism, researchers at the University of California, San Francisco (UCSF), announced recently.

Varenicline, currently marketed by Pfizer for smoking cessation under the trade name Chantix, dramatically curbed drinking in alcohol-preferring rats, according to the study, which was published online by The Proceedings of the National Academy of Sciences.

The synthetic drug was modeled after a cytosine compound from the European Labumum tree, combined with an alkaloid from the poppy plant.

Since an estimated 85 per cent of alcoholics are also cigarette smokers, varenicline could have an immediate effect on this common dual addiction. The drug has already been approved by the Food and Drug Administration (FDA) for human use, so Pfizer is likely to be granted a speedy approval for the new indication, sources say. The drug is likely to join Antabuse (disulfiram), Revia (naltrexone), and Campral (acamprosate) as FDA-approved treatments for alcoholism.
Selena Bartlett of the UCSF-affiliated Gallo Clinic and Research Center, a co-author of the study, said that the drug works by disrupting the neuronal “reward pathway” of the brain. Specifically, the drug binds to acetylcholine receptors, a neurotransmitter involved in arousal and attention. Through a cascade effect, stimulating these receptors causes a release of dopamine, one of the primary pleasure chemicals in the brain. Varenicline prevents alcohol and nicotine from causing a release of dopamine at those sites.

“Treatments for alcoholism today are like those for schizophrenia in the ‘60s,” Bartlett said. “People don’t talk about it. There are very few treatments, and most drug companies are not interested in it.”

Bartlett said she hoped the research would spur additional studies of drugs for alcoholism. "It’s a disease. If you’ve inherited a gene variant, of if some other cause leads you to alcohol dependence, it should be treated like any disease."

source: Blog Critics
author: Dirk Hanson

NY bans smoking at rehab centers

If alcoholics and drug addicts want to kick their habits, they'd better be ready to snuff out their cigarettes.

Indoors and outdoors, smoking will be banned at 1,400 recovery centers throughout the state starting next summer. In place of their butts, patients will be offered free treatment for their nicotine addictions.

The $8 million program offers addicts an "entire recovery plan," said Karen Carpenter-Palumbo, commissioner for the state Office of Alcoholism and Substance Abuse Services.

"We know that 92 percent of those addicted to alcohol or drugs are smokers," said Carpenter-Palumbo, who was in Middletown yesterday to meet with officials from Orange Regional Medical Center and Catskill Regional Medical Center.

"We know it's a trigger to alcohol and drug addiction. And we know smoking kills 25,000 New Yorkers each year."

But some counselors are concerned the smoking bans will stop some addicts from getting treatment.

"It's easier for the state to make this rule than for people to follow it," said Amado Valdes, supervisor at Restorative Management Corp. in Middletown. "I've helped people kick heroin, cocaine and alcohol. Maybe it's too much to ask them to do."

Repeat offenders of the smoke-free edict could be booted from state-certified programs under the new regulation.

"If they continue to smoke, they'll be moved to a different program or discharged," said Carpenter-Palumbo.

Monroe Bussey, program director at Catholic Charities Community Service in Newburgh, says that would be a mistake.

"We wouldn't want to kick anybody out for smoking," he said. "We need to understand that the needs of the client come first."

Bussey's center is among the 70 percent that currently allow smoking on the premises. He favors providing care for nicotine addiction along with treatment for alcoholism and drug dependency — but he wonders how difficult it will be to get patients and counselors to obey the new rule.

"We have a lot of staff that smokes," he said.

"They'll have to get used to the idea they can't smoke on the property. Nicotine is probably the most addictive substance in the world."

source: Times Herald-Record

From the streets to the classroom

From the rough streets of Vancouver's drug districts to the soft lecture hall seats at the University of Toronto, Nanaimo's Jason Devlin is taking an unorthodox path to becoming a doctor.

Today, Devlin is finishing up another summer in the Applied Environmental Research Lab at Malaspina University-College, where he has been working on innovative ways to measure contaminants in water. Six years ago the high school-dropout was living in Vancouver, spending his days with friends, high on heroin, as 'normal' life went on around them.

Devlin has travelled far from that place of his life, and he's not done yet. The recent bachelor of science graduate at Malaspina University-College packed up his desktop computer this week as he prepares for medical school in Ontario.

If there's one thing he learned, though, it's that he didn't get here on his own. Because of the services available for street kids in Vancouver, Devlin, now 23, was able to stay reasonably healthy until he was ready to recover.

He benefitted from the services, but he knows that many of the estimated 150,000 homeless youth across Canada often do not.

"Vancouver is very good to its homeless," he said.

"Without the services everybody would be hooking, robbing and stealing. It's weird because the services made it easier for me to stay in, but they were necessary for me when I wanted out."

With at least four years of medical school ahead of him, Devlin has yet to decide on a specialty, but he will likely return to the streets where he can battle the HIV/AIDS epidemic, or other communicable diseases that plague the country's poorest people.

Few doctors will have a story like Devlin's. His high school in Powell River expelled him at 14 because of his wild and elaborate clothing choice

Bored in his small town, he and friends would take Ritalin or whatever else they could find to get high.

He later became hooked on cocaine and crystal methamphetamine.

After two years of sleeping on the street, Devlin moved into an apartment, where he said things only got worse. He and his friends would pump heroin into themsleves and then simply lie around in their own filth, until it was time to get more. This pattern continued until the junkies set a date to kick their habits for good. When January 2002 came, only Devlin had actually reduced his drug use to the point where he could quit. Leaving his friends behind, he packed up and returned to his parent's home in Powell River.

When he finished the last of his small stash of heroin, Devlin said the pain was nearly unbearable.

To keep his mind off the long-term withdrawal symptoms, he enrolled in adult basic education programs at the Malaspina campus in Powell River. A year later he graduated high school and enrolled in a four-year degree program in Nanaimo. During his four years he won the Undergraduate Summer Research Award from the Natural Sciences and Engineering Research Council three times. He also received the Governor General's Academic Silver Medal for outstanding achievement in a four-year degree program.

Devlin hopes those achievements, combined with his academic knowledge and unique personal experiences, will give him the skills he needs to bring his life full circle: Back to the streets of Vancouver, to help those who need it most.

author: Derek Spalding

DSpalding@nanaimodailynews.com