All posts by Cupcake

I'm the naked cupcake! I'm 27, from the NYC area and currently intern as a drug and alcohol counselor working toward my CASAC and I'm also a Recovery Coach certified by OASAS. I design websites in my spare time and I'm currently working on my "Geek and Nerd" blog on WordPress. I love technology, computers, my xbox and video games and my furry little one - Butters, my rabbit! I'm a mother of 3 amazing children Joseph Jr (4 1/2), Isaiah (6) and Jeremiah (10 1/2). Having children was the BEST thing to happen to me. I've been blessed with such great kids!! We love to play video games together, stay up all night drinking juice and eating pretzels, playing video games! I've been 2 1/2 years sober and I wouldn't have been able to do it without my kids. They push me to do greater things in life.

Treating infants of mothers with opioid dependence

As more infants are born to mothers with dependence on prescription pain medications, the costs of treatment for babies with neonatal abstinence syndrome (NAS) have increased dramatically, suggests a report in the March/April issue of the Journal of Addiction Medicine, the official journal of the American Society of Addiction Medicine. The journal is published by Wolters Kluwer.

“At our institution, costs associated with treating infants with NAS are exponentially higher than the costs associated with infants not affected,” write Dr. Kay Roussos-Ross, Assistant Professor of Obstetrics and Gynecology, and colleagues of University of Florida College of Medicine, Gainesville. The researchers believe their findings support recent recommendations to screen or test for substance use in pregnant women.

Rising Treatment Costs for Neonatal Abstinence Syndrome

Nonmedical use of prescription opioid pain medications during pregnancy has increased fivefold since the late 1990s, according to a recent study. Some infants born to women with opioid use disorder will develop neonatal abstinence syndrome — symptoms and complications related to withdrawal from the opioid pain medication to which they were exposed in utero.

Dr. Roussos-Ross and coauthors analyzed cost trends for infants with NAS at one university-affiliated hospital between 2008 and 2011. They identified 160 opioid-exposed newborns: 40 in the first year of the study, 57 in the second year, and 63 in the third year.

Ninety-five of the infants were exposed to “opioid agonist” drugs — methadone or buprenorphine — given during pregnancy to treat the mother’s opioid use disorder. The rest were exposed to various “short-acting” prescription opioids taken illicitly by the mother.

In each year, about 50 to 60 percent of opioid-exposed infants developed symptoms of NAS. These infants remained in the hospital after birth for an average of 23 days, compared to the usual post birth stay of one or two days for a normal healthy newborn. For opioid-exposed infants who did not develop opioid withdrawal symptoms, the average hospital stay was about five days.

The total costs of treatment for NAS rose sharply: from about $1.1 million in the first year, to $1.5 million in the second year, to $1.8 million in the third year. These costs were 15 to 16 times higher than of healthy infants.

The rising rates and costs of NAS reflect the ongoing “opioid epidemic” in the United States. The results add to other recent studies showing high costs for treatment for babies born to women with opioid dependence. Those previous studies found that most of the costs are paid by state Medicaid programs.

Dr. Roussos-Ross and coauthors suggest some steps to help address the high financial and human costs associated with neonatal abstinence syndrome. They encourage doctors to be “proactive in screening for drug use, urging women who use chronic opioids to actively engage in family planning and contraception, and encouraging pregnant women who use opioids to seek substance treatment.”

The researchers note that although universal screening for drug use during pregnancy has been recommended by major specialty organizations, it is not yet standard practice. They also call for studies to improve the management of NAS and for follow up of evidence that buprenorphine may lead to better treatment outcomes, in comparison to methadone, in the treatment of pregnant women with opioid use disorder.

Advertisements

New test detects drug use from fingerprints

Research published in the journal Analyst has demonstrated a new, non-invasive test that can detect cocaine use through a simple fingerprint. For the first time, this new fingerprint method can determine whether cocaine has been ingested, rather than just touched.

Led by the University of Surrey, a team of researchers from the Netherlands Forensic Institute (NL), the National Physical Laboratory (UK), King’s College London (UK) and Sheffield Hallam University (UK), used different types of an analytical chemistry technique known as mass spectrometry to analyse the fingerprints of patients attending drug treatment services. They tested these prints against more commonly used saliva samples to determine whether the two tests correlated. While previous fingerprint tests have employed similar methods, they have only been able to show whether a person had touched cocaine, and not whether they have actually taken the drug.

“When someone has taken cocaine, they excrete traces of benzoylecgonine and methylecgonine as they metabolise the drug, and these chemical indicators are present in fingerprint residue,” said lead author Dr Melanie Bailey from the University of Surrey. “For our part of the investigations, we sprayed a beam of solvent onto the fingerprint slide (a technique known as Desorption Electrospray Ionisation, or DESI) to determine if these substances were present. DESI has been used for a number of forensic applications, but no other studies have shown it to demonstrate drug use.”

Researchers believe that the applications for this test could be far-reaching. Drug testing is used routinely by probation services, prisons, courts and other law enforcement agencies. However, traditional testing methods have limitations. For example, blood testing requires trained staff and there are privacy concerns about urine testing. Where bodily fluids are tested, there can be biological hazards and often a requirement for particular storage and disposal methods. Often these tests also require analysis off-site.

“The beauty of this method is that, not only is it non-invasive and more hygienic than testing blood or saliva, it can’t be faked,” added Dr Bailey. “By the very nature of the test, the identity of the subject is captured within the fingerprint ridge detail itself.”

It is anticipated that this technology could see the introduction of portable drug tests for law enforcement agencies to use within the next decade.

“We are only bound by the size of the current technology. Companies are already working on miniaturised mass spectrometers, and in the future portable fingerprint drugs tests could be deployed. This will help to protect the public and indeed provide a much safer test for drug users,” said Dr Bailey.

New pharmaceutical product to prevent heroin deaths

A new, lifesaving product aimed at reducing the death toll from heroin abuse — developed by a professor at the University of Kentucky College of Pharmacy — is in its final round of clinical trials and has received Fast Track designation by the Food and Drug Administration.

The product, a nasal spray application of the anti-opioid drug naloxone, was developed by Daniel Wermeling, UK professor of pharmacy practice and science, through his startup company AntiOp Inc.

Naloxone is the standard treatment for suspected opioid overdose, already in use by emergency rooms and emergency medical technicians across the country. Opioids are the class of pain-killing drugs that are related to morphine, including prescription drugs such as hydrocodone and oxycodone, as well as illegal drugs such as heroin.
Currently, naloxone is administered by injection. The nasal spray eliminates the need for needles, with a ready-to-use, single-use delivery device inserted into the nose of an overdose victim. The product delivers a consistent dose, absorbed across the nasal membranes even if the patient is not breathing.

“The goal is to make the medication available to patients at high risk of opioid overdose, and to caregivers, including family members, who may lack specialized medical training,” Wermeling said. “The treatment could be given in anticipation of EMS arrival, advancing the continuum of care and ultimately saving lives.”

Nationwide, deaths from opioid overdose are on the rise, according to data from the Centers for Disease Control and Prevention. Kentucky, long troubled by widespread abuse of prescription opioids, has seen a dramatic rise in deaths from heroin overdose in recent years. In autopsies from 2013, the state medical examiner attributed 230 deaths to heroin overdose, an increase of more than 60 percent from the previous year.

UK President Eli Capilouto congratulated Wermeling on his success with AntiOp, saying that it reflects the core values of the university.

“Too many Kentucky families have experienced the tragedy of seeing a loved one’s life cut short by a drug overdose,” Capilouto said. “The epidemic of opioid abuse in our state presents an enormous and urgent challenge, not only for health care providers and law enforcement, but also for us here at the University of Kentucky. Dr. Wermeling’s project is putting a powerful new tool into the hands of those on the front line of the fight against heroin, both here in Kentucky and beyond. This type of innovation embodies the three main components of the university’s mission — education, research and, above all, service.”

UK College of Pharmacy Dean Timothy S. Tracy said Wermeling’s work also provides an illustration of “bench-to-bedside” research in action. “Dr. Wermeling’s project is a great example of how UK College of Pharmacy faculty are working each and every day to create healthier Kentucky communities,” Tracy said. “Dr. Wermeling and his collaborative team of research colleagues saw a problem facing families in Kentucky and across the nation and developed an innovative solution. That type of translational approach is important to our college, this university, and, of course, the future of our Commonwealth.”

Wermeling’s research was supported by a three-year, $3 million grant from the National Institutes of Health through the National Institute on Drug Abuse with additional funding from the Kentucky Science and Technology Corporation. In May, AntiOp partnered with Reckitt Benckiser Pharmaceuticals to accelerate production and worldwide marketing of intranasal naloxone.

The Fast Track program of the FDA is designed to expedite the development and review of new drugs that are intended to treat serious or life-threatening conditions and that demonstrate the potential to address unmet medical needs. Fast Track-designated drugs ordinarily qualify for priority review, thereby expediting the FDA review process.
“As an educator, pharmacist, researcher and entrepreneur, being able to work on this naloxone project has been a dream come true,” Wermeling said. “I often tell my students and colleagues that this project has allowed me to use all of the skills I have learned over the years. It has been the ultimate problem-solving project, requiring me to utilize my pharmacological skills, my drug delivery knowledge, my business and marketing skills — all at the same time.

“At the end of the day, however, this project has always been about people. It has always been about utilizing the knowledge and skills that we have to improve patient care.”

A video featuring Dr. Wermeling discussing this work may be viewed online at https://www.youtube.com/watch?v=pgjIH5KkH0k

Pakistani Clinic ‘Treats’ Drug Addicts With Beatings and Torture

Hashish addict Noor Rehman has spent three years chained to a concrete slab covered by insects.
Beaten and malnourished, he lost his eyesight in a “clinic” run by a Pakistani mullah claiming to cure addicts who were kept against their will and forced to recite the Koran.

“They treated us worse than animals,” the 30-something with a salt and pepper beard muttered among a room full of mullah Maulana Ilyas Qadri’s last remaining patients, all clapped in irons.

When police broke into the clinic last week in Haripur, a city built on a hill around 80 kilometres north of Islamabad, they found 115 ‘patients’ chained in pairs and shackled to the ground.

Most have now been freed and Qadri has been arrested, but around 20, including Noor, are waiting for their families to come and take them home.

The clinic’s methods fall on the more extreme end of the spectrum — even for Pakistan — but offers some insight into how the conservative Islamic nation deals with the taboo subject of drug addiction.

Observers say a lack of legal oversight allows such institutions as well as some mental asylums to become places where families can ‘do away’ with inconvenient relatives.

To prevent inmates from escaping and getting back on to drugs, Qadri left them permanently chained, day and night — except for a few precious moments to go to the bathroom, still chained to their partner.

If they uttered a word of complaint, they were beaten by the mullah and his four guards.

– ‘No therapy, just chains’ –

“They tortured us! By the end of it, patients developed mental issues,” said Noor, who lost his sight eight months ago after two years of confinement.

“It was due to psychological pressure and stress,” he said. Unhygienic conditions where an eye-infection would likely go untreated may have also played a part.

Noor’s brother took him to the centre after discovering his hashish addiction. But he could never imagine himself being imprisoned, let alone becoming handicapped as a result.

Like many other “patients” he blames his family — in this case his brother, who he accuses of leaving him at the centre so he could steal his lands.

Shafiullah, an Afghan refugee with a sinewy physique and bright, turquoise eyes, added: “There was no therapy here, just chains.

“The mullah lets us go out only when he wants our help in construction work. It was us who built these walls,” he said, still chained to a fellow patient.

Others said they were forced to cook and clean in the absence of staff.

Many became addicted to the widespread and — at 50 US cents a hit — cheap drug, with Pakistan a hub for opium smuggled in from neighboring Afghanistan since the 1980s.

Today, Pakistan has more than four million cannabis consumers and more than 860,000 heroin users, a figure which has doubled since 2000 according to a recent UN survey.

Many detoxification clinics offer primitive therapies. Some isolate their patients behind bars — but it is unusual for them to be deprived of their freedom.

– ‘Nothing to do with Islam’ –

A complaint by the family of one patient at Qadri’s clinic led to a police raid and his downfall. Locked up at Haripur police station, the incarcerated mullah continued to defend his controversial methods, even as he faces the prospect of jail time for torture and illegal confinement.

“I recite the Koran, then blow on water and give this water for drinking three times a day. Normally the addicts who stop using have the tendency to vomit and shake. But thanks to the Surah Yassin (a verse) they don’t have problems,” said the self-proclaimed healer.

“And then one week, without any medicine, they are better. Even in the top institutions you will never see this,” he boasted, while calling himself a victim of police corruption for failing to pay them a bribe.

“He chained us and beat us with a stick. This has nothing to do with Islam,” responded ex-patient Shafiullah.

The controversial mullah was previously arrested in 2006 for imprisoning patients in his clinic. But he was released under bail and then acquitted.

He then re-opened his centre where his shock therapy costs each family Rs8000 ($80) per month.

During family visits, patients were instructed to say “everything is okay, else they would be beaten” said Mehboob Khab, head of the police station where the Mullah is jailed.

But his controversial methods also found approval among many families.

“When he’s chained up, my son cannot escape. These chains are doing him good, and on top of it he has learnt to recite the Koran,” said a man called Sultan, who was outraged by the closure of the centre.

Niaz, who came to pick up his brother Lutuf, said the treatment was necessary. “My brother needed this severe treatment. Without it he would get back on the drugs.”

Lutuf stared blankly into space for a moment before responding.

“My brother doesn’t know the whole story. I know what happened here.”

A Different Path to Fighting Addiction

When their son had to take a medical leave from college, Jack and Wendy knew they — and he — needed help with his binge drinking. Their son’s psychiatrist, along with a few friends, suggested Alcoholics Anonymous. He had a disease, and in order to stay alive, he’d have to attend A.A. meetings and abstain from alcohol for the rest of his life, they said.

But the couple, a Manhattan reporter and editor who asked to be identified only by their first names to protect their son’s privacy, resisted that approach. Instead, they turned to a group of psychologists who specialize in treating substance use and other compulsive behaviors at the Center for Motivation and Change.

The center, known as the C.M.C., operates out of two floors of a 19th-century building on 30th Street and Fifth Avenue. It is part of a growing wing of addiction treatment that rejects the A.A. model of strict abstinence as the sole form of recovery for alcohol and drug users.

Instead, it uses a suite of techniques that provide a hands-on, practical approach to solving emotional and behavioral problems, rather than having abusers forever swear off the substance — a particularly difficult step for young people to take.

And unlike programs like Al-Anon, A.A.’s offshoot for family members, the C.M.C.’s approach does not advocate interventions or disengaging from someone who is drinking or using drugs. “The traditional language often sets parents up to feel they have to make extreme choices: Either force them into rehab or detach until they hit rock bottom,” said Carrie Wilkens, a psychologist who helped found the C.M.C. 10 years ago. “Science tells us those formulas don’t work very well.”

When parents issue edicts, demanding an immediate end to all substance use, it often lodges the family in a harmful cycle, said Nicole Kosanke, a psychologist at the C.M.C. Tough love might look like an appropriate response, she said, but it often backfires by further damaging the frayed connections to the people to whom the child is closest.

The center’s approach includes motivational interviewing, a goal-oriented form of counseling; cognitive behavioral therapy, a short-term form of psychotherapy; and harm reduction, which seeks to limit the negative consequences of substance abuse. The psychologists also support the use of anti-craving medications like naltrexone, which block the brain’s ability to release endorphins and the high of using the substance.

A 2002 study conducted by researchers at the University of New Mexico and published in the journal Addiction showed that motivational interviewing, cognitive behavioral therapy and naltrexone, which are often used together, are far more effective in stopping or reducing drug and alcohol use than the faith-and-abstinence-based model of A.A. and other “TSF” — for 12-step facilitation — programs. Results of an updated study have not yet been released.

Researchers elsewhere have come up with similar findings. In 2006, the Cochrane Library, a health care research group, reviewed four decades of global alcohol treatment studies and concluded, “No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems.” Despite that research, A.A.’s 12-step model is by far the dominant approach to addiction in America.

Jack and Wendy’s son, who is in his early 20s, began drinking to alleviate crippling anxiety and ease persistent depression. His drinking, while worrisome, was not an entrenched pattern, his parents believed. Some of Jack’s friends suggested that if their son did not attend A.A. of his own volition, the only thing Jack and Wendy could do was attend Al-Anon.

“The implication was that there was no other solution,” Jack said. “There was a great deal of sadness on their part, empathetic sadness, which in some ways was frightening in itself.”

“A lot of people credit A.A. with saving their lives,” he added. “It’s understandable that they can’t dissociate themselves from a program that worked for them. But it’s an all-or-nothing commitment for life. That really freaked me out.”

In A.A.’s literature, “alcoholism” is defined as “a progressive illness that can never be cured.” Members describe themselves as being “in recovery,” which translates to lifelong abstinence and adherence to the 12 steps mapped out in the Big Book, published four years after the organization was founded in 1935. First among them is the obligation for members to admit their “powerlessness” over alcohol. It also relies heavily on faith; God is mentioned in five of the 12 steps.

On a warm evening last month, about a dozen parents gathered to hear Dr. Kosanke describe the center’s program for families, which goes by the acronym Craft, for Community Reinforcement and Family Training. It rejects, she said, the use of three words: “addict,” “alcoholic” and “enabling,” a term often used to describe the acts of loved ones that help perpetuate unhealthy behaviors.

Instead of addict or alcoholic, she prefers the terms favored by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or the DSM-V, which says that patients suffer from “alcohol use disorder” or “substance abuse disorder,” terms that convey a spectrum of severity.

“Substance use takes on a lot of different shapes and sizes,” Dr. Kosanke said. “There are real downsides to labeling a child with a lifetime identity, when that truly may or may not turn out to be the case.”

And calling caring behavior enabling, she said, has a way of turning even acts of kindness into something negative. “Our field hasn’t done a good job of defining it in a narrow way that’s appropriate,” she said. “If you give your kid money knowing he will go buy pot, that’s enabling. If you take your kid to soccer practice, you’re encouraging healthy behavior. That’s not ‘enabling.’ ”

Part of the Craft approach has parents take care of themselves, too, said Lorraine McNeill-Popper, who volunteers for the parent hotline at the Partnership for Drug-Free Kids, a nonprofit group devoted to recovery for young people. “If you are sleep-deprived and stressed out, how can you think clearly?” she said.

Ms. McNeill-Popper has her own family history of drug abuse. Her twin brother died of an overdose, and she adopted his son, who later became a heavy marijuana user and ended up in rehab. “I tell parents, ‘It’s like when you’re on an airplane, and they tell you to put the oxygen mask over yourself first. That way you can help with the others.’ ”

The center’s approach is controversial in the recovery world. David Rotenberg, executive vice president of treatment at the nonprofit Caron Treatment Centers, a large drug and alcohol rehabilitation provider with branches in several states, cautioned against approaches that do not set abstinence as a goal.

“The majority of people who are chemically dependent would love to be able to drink and drug in a more moderate fashion,” Mr. Rotenberg said. “Most drug addicts and alcoholics would love to drink just a couple of drinks, and they try to do so, with poor results.”

The C.M.C. doctors say treatment for young people needs to be tailored for them, since teenagers and young adults are neurologically, psychologically, socially and legally different from adults, and have different treatment needs.

Dr. Wilkens founded the center with a fellow psychologist, Jeffrey Foote, in 2003. The two had worked together in larger hospital-based treatment centers where they struggled to introduce evidence-based treatments, she said. When it opened, the C.M.C. was one of the few centers in the nation that were not tethered to the 12-step model, she said.

“It was our strong belief that you can work with people at any stage of change, ranging from ‘I’m not even sure I have a substance problem’ all the way to ‘I just got out of rehab and want to go to A.A. meetings every day,’ ” Dr. Wilkens said. “We don’t have a judgment on how you address your substance use problem. Maybe A.A. is helpful to you and you find everything you need there. If it’s not, we genuinely believe there are many strategies for helping to resolve them.”

In fact, a majority of college binge drinkers do not go on to become alcohol dependent, said Stanton Peele, a Brooklyn psychologist who has studied substance use for decades and is a longtime critic of the A.A. model. While binge drinking and other drug use are risky, multiple studies show that most people “mature out” of such recklessness when they begin to have increased responsibilities.

A federally financed study of 43,000 randomly selected Americans, called the National Epidemiologic Survey on Alcohol and Related Conditions, or Nesarc, found that 75 percent of those who are heavy drinkers eventually regain control without rehab or A.A., Dr. Peele said. The survey, which was conducted in the early 2000s and was designed to be representative of the larger United States population, was aimed at helping researchers understand high-risk drinking patterns, design better-targeted treatment programs and monitor recovery. It found that over half of those who recover managed to cut back instead of abstaining, Dr. Peele said.

“Isn’t it more encouraging to know that most people are going to outgrow these habits than to think they’re going to have a disease for the rest their lives?” Dr. Peele asked. “The data show that the odds are in your favor.”

Dr. Wilkens is familiar with that pattern. She was a college binge drinker herself and also struggled with bulimia. Once she left her home state of Kansas for New York City, where she attended Hunter College, she felt culturally stimulated and intellectually challenged, she said, and the drinking and disordered eating disappeared.

“When you focus on building up the world around you, you find stimulation and rewards that are very different from using drugs and alcohol. You find other ways of soothing yourself, and things can get better,” she said.

That is precisely what L.S. learned five years ago. L.S., a Manhattan lawyer in his early 30s who asked to be identified only by his initials to protect his privacy, spent nearly a decade as an episodic binge drinker. He began drinking as a student at his large Midwestern university, where he played rugby and where many of his best friends belonged to fraternities. Alcohol, he said, flowed freely through both subcultures. L.S. said he thought his drinking — weeks of no drinking followed by serious binges of a few dozen drinks over several days — would end after college. Yet the behavior did not fade. The morning after his wedding, he awoke with a hangover that lasted a day and a half.

His father, who drinks socially, told him that people either were alcoholics or were not. But L.S. was unprepared to accept that label and began researching moderation on his own. He found a New York branch of Moderation Management, or M.M., a secular, peer-led support group that takes a cognitive behavioral approach.

In contrast to A.A., which stresses a drinker’s lack of power in the presence of alcohol, M.M. encourages personal responsibility for drinking. The group, founded in 1993, encourages members to start with an alcohol-free month, and then allows for the reintroduction of moderate amounts of alcohol. (Critics note that one of its founders, Audrey Kishline, was involved in a fatal accident while driving drunk. She left the group in January 2000 with the intention of joining A.A., and three months later, crashed head-on into another vehicle, killing the driver and his 12-year-old daughter.)

L.S. now attends hourlong meetings once a week at which he and about a dozen others discuss their goals for moderate drinking, as well as tips, challenges and progress on avoiding triggers. Since he began attending, L.S. limits himself to about five drinks a week, well below the 14 drinks M.M. advises as a safe limit for men.

L.S. is convinced that there is no single approach for all problem drinkers. “M.M. doesn’t profess to work for everybody. It has a scientifically based approach that works for some people,” he said.

The C.M.C. psychologists are blunt about the reasons many teenagers and young adults use drugs: When it comes to decreasing anxiety and relieving depression, substances tend to work for the short term. “Kids aren’t crazy for using them,” Dr. Wilkens said. “They have an effect that is reinforcing in some way. If you understand that, you can strategically work to support and reinforce other healthy, competing behaviors.”

That approach runs through the book she wrote with Dr. Foote and Dr. Kosanke, “Beyond Addiction: How Science and Kindness Can Help People Change.” It was published in February, just as the death of Philip Seymour Hoffman from a heroin overdose struck fear in the hearts of many parents whose children use drugs. It landed Dr. Wilkens on several talk shows and drew scores of calls to the center. (In addition to its New York office, the group has opened a residential treatment center in the Berkshires.)

Dr. Wilkens’s message struck a chord with Wendy. Her son had just left school, and the couple was exploring treatment options. Wired in the evenings with extreme anxiety, he drank excessively to get himself to sleep. Once in bed, he’d stay there till 5 p.m.

Before she read the book, Wendy said, she would stomp upstairs hourly to announce in an exasperated voice, “It’s 2 o’clock. You’ve got to get out of there.”

“I’d do that three or four more times and then be fuming,” she said. “I’d be fuming all day, at home doing my work and knowing he was upstairs sleeping off whatever he’d been drinking the night before.”

After learning the Craft approach, Wendy said, she stopped nagging, changing her negative, accusatory tone to a more pleasant one by asking open-ended questions.

Today, Wendy and Jack’s son is working with his psychiatrist and getting help for his depression and anxiety. He seems to be bingeing much less. When the family went out to dinner on a recent night, the parents each ordered a beer or a glass of wine and sipped slowly through dinner. “How will he learn moderation if he doesn’t see it modeled?” Wendy asked.

Ellie hopes her daughter, too, will be able to change her drinking patterns. Ellie is a New York editor, who asked that her last name be withheld to protect her family’s privacy. Her daughter, 23, has struggled with binge drinking since she was 16. While her daughter graduated from college and holds a responsible job, she still binges on weekends. “It’s so much a part of the culture, it’s everywhere,” Ellie said. “She says she’d have no social life if she stopped drinking.”

Ellie, who grew up in a home in which many relatives attended A.A., at first tried Al-Anon. “They talk about ‘disengaging,’ ” she said. “But it’s your child, and I’m not one of those people who can put her out on the street.”

While their daughter has resisted treatment so far, Ellie and her husband have begun seeing a therapist at the C.M.C. to better navigate their relationship.

“My child is much more than a label or a diagnosis,” she said. “She’s not a problem to be solved, but a child to be loved and guided toward a better life.”

Source:  The New York Times

Starbucks Adding Alcohol to Evening Menu

Popular coffee chain Starbucks is expanding its evening menu with bacon-wrapped dates and Malbec wine. The rollout of new products to almost all of Starbucks’ thousands of locations will take several years, according to Chief Operating Officer Troy Alstead.

“We’ve tested it long enough in enough markets – this is a program that works,” Alstead said. “As we bring the evening program to stores, there’s a meaningful increase in sales during that time of the day.”

The addition of wine to its stock is part of a campaign to increase the chain’s market value to $100 billion, a plan that includes more non-coffee items such as alcohol, juice, food, and an app that will allow customers to order ahead from their smartphones for pickup.

Starbucks first sold alcohol in October 2010 at a Seattle location and expanded the program to Chicago, Atlanta, and Southern California in 2012.

The new evening menu is in about 40 locations now, but won’t be expanding to all of its stores. The company has seen the menu succeed in urban areas where people are out at night, said Alstead, and the menu’s availability will follow suit.

Starbucks has over 20,100 locations worldwide, with 11,500 stores in the United States.

Michigan Senate Approves Drug Testing of Welfare Recipients

Despite the stigmatization of welfare recipients and the failure of testing programs in other states, Michigan went ahead and passed the bill anyway.

Michigan could become the latest state to approve the drug testing of welfare recipients. The state Senate approved the second of two bills which would allocate $500,000 for the Department of Human Services (DHS) to create pilot testing programs in at least three counties.

The proposed plan calls for DHS to use a substance abuse screening tool on select welfare recipients. Those suspected of using illegal substances would then be required to take a drug test. A positive test would result in the recipient being referred to a regional substance abuse agency for intervention, with a second positive test or refusal to participate resulting in the recipient having their benefits taken away for at least six months.

“The vote you are about to take is not a vote against the poor of this state. This vote is for the children,” said Sen. Rick Jones (R-Grand Ledge). “Children are starving. They’re hungry in this state. We have to feed them at school because their parents are abusing drugs at home.”

All eleven Democrats at the hearing opposed the testing out of fear that it stigmatized welfare recipients, whose rate of drug use is no different than that of the general population. “I’m continually frustrated by the priorities of this Legislature, in particular the ongoing attacks on low-income families,” said State Sen. Vincent Gregory (D-Southfield). “Michigan gives businesses nearly 40 billion in tax handouts, yet those companies are not required to be drug tested, let alone to create the jobs they promised.”

Democratic senators did successfully add two amendments to the bill that would allow guardians to receive benefits for children if their parents were kicked off welfare, as well as protecting certified medical marijuana patients from punishment. Nine states currently test welfare recipients for drugs, but current data suggests that the programs actually cost more money than they save since only a small percentage of welfare users end up testing positive.

Snail Venom Has Potential to Create Powerful New Painkillers

Though still in the research phase, the venom-filled treatment could produce a new class of drugs one hundred times more powerful than morphine.

Ocean-dwelling cone snails have become responsible for one of the most powerful drugs on the planet. Australian researchers have created a drug using venom from cone snails that is reportedly 100 times more powerful than morphine and “appeared to significantly reduce pain.”

The Sydney Morning Herald has noted that the still-unnamed drug doesn’t have the addictive components of other painkillers. The primary ingredient in the drug is conotoxin, a compound secreted by cone snails.

But as of now, it has only been tested on rats and a human trial is still two years away. “We don’t know about side effects yet, as it hasn’t been tested in humans. But we think it would be safe,” said lead researcher David Craik of the University of Queensland in Australia. The goal of the drug is to manage neuropathic pain, which affects 15 percent of the U.S. population and can arise from cancer, AIDS, diabetes, and other debilitating diseases.

Craik thinks that the venom-filled treatment could open up a “whole new class of drugs capable of relieving one of the most severe forms of chronic pain that is currently very difficult to treat.” A painkiller with conotoxin called ziconotide has already been approved for human use, but is not available in pill form and requires a spinal cord injection.

Addiction Brain Scans, Unscrambled

We’re used to media splashes about so-called “holes” in the brain. But what neuroimaging really tells us about the effects of drug use is much subtler—and much more helpful.

We’ve come a long way since; the advent and exponential development of neuroimaging techniques allows us to visualize the mind’s hardware—and how it goes awry in addiction—in increasing detail and nuance. But the media bombardment of brightly-colored brain images can be overwhelming—and important points get lost. These slides are meant as a primer on some of the biggest stories to have emerged in addiction neuroimaging, and the insights they give. Of course, these examples are only a thin sliver of the available science—and scientists are still grappling with addiction’s overwhelming complexity. Without dismissing other relevant brain systems or equally important socio-cultural and environmental influences, our focus here is the striatum: a set of structures heavily involved in reward, motivation, habit formation—and the brain’s dopamine system.

One of the earliest addiction imaging experiments was also one of the gutsiest: in 1989 researchers set out to find what cocaine actually did in the brain, where it went, and what that meant. They tagged cocaine with a radioactive element, injected it into healthy volunteers, and used PET (positron emission tomography) to measure the location and time-course of radioactivity emitted. The result? Coke went straight to the striatum: the home of reward signaling and the formation of consequent behaviors. Here we see a horizontal brain slice over time (in minutes). The “hotter” colors represent more cocaine (the striatum is the two sickle-shaped hot-spots near the middle). The study also investigated time-course (right), showing the rapid cocaine uptake needed for a high—this paralleled the subjective effects reported by the volunteers, suggesting the two are related. The work demonstrated in humans that cocaine’s direct effects on the striatum and time-course modulate its subjective effects. The study was later repeated using methamphetamine instead (bottom row): the binding again primarily involved the striatum, but also extended to many other areas. The time-course, again paralleling subjective experience, was much longer-lasting than cocaine—explaining differences between the two stimulants in duration, subjective experience and long-term effects.

Sometimes it’s less obvious why people enjoy a drug. This recent study investigated psilocybin (magic mushrooms), a compound that binds to serotonin receptors and doesn’t have obviously rewarding dopamine effects. MRI (magnetic resonance imaging) was used to measure the magnetic properties of blood flowing into the brain, with the idea that active regions need more blood. Researchers injected volunteers with the drug and placebo, and measured changes in blood flow and oxygenation. To everyone’s surprise, MRI measures decreased with psilocybin, mainly in regions other than the striatum (yellow circle), including areas involved in association, consciousness and “constraining the experience of the world.” The scatterplot shows that the amount of decrease in MRI signal predicted the intensity of subjective effects. The study also found reduced communication between brain regions, suggesting that “decreased activity and connectivity” permits “an unconstrained style of cognition.” So some drugs without a direct striatum/dopamine effect can be found enjoyable, perhaps due more to the reward of changing perceptions—a uniquely human feature that seems hard to model in animals. In a separate study, the group also found that MRI measures related to memory vividness and subjective well-being at follow-up, suggesting a biological basis to the proposed use of psilocybin in psychotherapy.

One of the most consistent “hallmarks” of addiction is that levels of the D2 subtype of dopamine receptors (mostly found in the striatum) are lower in addicted than in non-addicted individuals. These images come from a number of PET studies which assessed D2 receptor levels, by injecting subjects with a radioactive compound that specifically binds to dopamine receptors and comparing levels between groups. The “cooler” colours indicate lower D2 levels in the addicted groups. This represents the possible identification of an addiction “biomarker”—an objective biological measure that can be investigated, monitored and perhaps manipulated for prevention or treatment. The real-world relevance of this is shown in the pink inset: in two studies (cocaine and meth), addicted subjects had their D2 levels measured, went through treatment, and were then contacted again to assess treatment success. Successful responders to treatment were found to have higher D2 levels than those who had relapsed, suggesting that D2 levels have some predictive value for success. Much remains to be filled-in in the dopamine receptor/treatment response black box. But this knowledge can help in the allocation of clinical attention and resources, or the identification of patients who may benefit from one type of treatment—like meds to increase dopamine transmission—over another.

The D2 dopamine receptor has also been used to investigate signs of recovery after abstinence. In this PET image, the “cooler-coloured” striatum of a one-month-abstinent meth user shows lowered binding of the radioactive compound, suggesting fewer receptors. But the striatum grows “bright” again after 14 months’ abstinence, suggesting increase in D2 receptor availability, or recovery of the receptors. This implies that brain cells don’t necessarily disappear permanently, but may temporarily adapt (perhaps retracting receptors in response to the dopamine bombardment from drug use)—or else that the remaining brain cells can compensate. Unfortunately, behavioral tests in the same study didn’t improve as much as D2 measures, and the finding has been difficult to replicate, which limits the study’s implications—but it does show the importance of timing in studies, and suggests that neurochemical changes aren’t necessarily permanent. (By the way, the black spots in the 14-month image are not holes in the brain, but a result of assigning colors to values, and setting the threshold at a certain level).

One problem with neuroimaging is that the pictures often don’t reveal much about functional relevance. How, if at all, do receptor levels translate to differences in experience, behaviour, thinking or feeling? This PET study measured the relationship between dopamine receptors and personality traits. The striatum blobs shown here don’t display radioactivity indicating D2 receptor levels, but rather the strength of the correlation between receptor levels and trait impulsivity (“hotter” colors mean a tighter relationship). In both meth-dependent and healthy subjects, the measures correlated inversely: those with the lowest D2 receptor availability were the most impulsive. This shows that dopamine receptor availability in the striatum can contribute to personality traits for the entire population—and addicted individuals, who tend to be on the low end of the D2 spectrum, are more likely to act impulsively than non-addicted individuals. It’s still frustratingly hard to determine what came first: drug use could cause a decrease in D2, or alternatively, low D2/high impulsivity could make people likelier to use drugs. Still, the study gives the “low D2 addiction biomarker” some behavioral meaning. It also explains some aspects of initiating or continued drug use, and raises clinical implications—as personality traits can be easily assessed and maybe used to evaluate dopamine-related intervention strategies.

Genetic factors contribute significantly to addiction, and imaging techniques can pick up and visualize genotype effects that less sensitive behavioural or self-report measures may not. This study investigated how genetic variation in the dopamine system affects smoking. Dopamine release in a certain part of the striatum is often considered the brain’s reward signal, and can be assessed in humans using PET. This requires measurement of a dopamine receptor-binding radioactive compound at two time-points; the difference between the points shows how much dopamine was released over time, knocking the compound off the receptor. The lower the second PET signal, the more dopamine was released. Subjects were scanned before and after a smoke break, then divided by genotype for three components of the dopamine system—each of which varies in function depending on genotype. Each row on the slide is a component: top, the dopamine transporter; middle, the D4 dopamine receptor; bottom, an enzyme that removes dopamine after release. For all three components, individuals with one genotype (left two panels) released more dopamine during the smoke break than those with another genotype (right two panels). So some people, due to their genetic makeup, find smoking more rewarding than others—and are likelier to continue or escalate use. Tiny biological differences can influence addiction processes, and a better understanding of them can aid prevention and intervention.

Behavioral or process addictions, like compulsive gambling, eating, or sex, have been getting lots of neuroimaging attention, partly due to their surface similarities with drug addiction, but their neurobiology remains largely unexplored. These results from several PET studies measuring D2 dopamine receptors in the striatum show that obese individuals who may be prone to compulsive overeating have low D2 levels—paralleling findings in compulsive drug users. This suggests biological commonalities between behavioural and drug addictions; it’s an exciting area currently gaining research momentum. Interestingly, in compulsive gambling—the only behavioural compulsion currently proposed for re-classification to addiction—low D2 receptor levels haven’t been found, although several studies have searched. This may mean that low D2 levels are sufficient, but not necessary, to drive addiction, and that other factors play a more important role here—or that the low D2 levels seen in drug addicts relate to the effects of drugs themselves, rather than addiction per se. This is a unique chance for scientists to learn about addiction without the potentially interfering effects of drugs, but clinically there are potential problems: drug addiction treatment options may have different effects when aimed at behavioural addictions. Of course, other biological parallels with drug addiction have been identified, and neuroimaging has played an important role in teasing apart the results.

Neuroimaging has enabled many advances in addiction science; it’s also added to the debate on personal culpability in addiction, by highlighting neurobiological factors that aren’t necessarily under our control. But the emotive influence of these images can also be used to more sinister effect, manipulating audiences into knee-jerk reactions. Sometimes this is done for the sake of eyeballs and obviously overwrought (right panel)—but other uses are more serious, including court evidence to support drug-related penalties. Even if an image comes from reputable scientific sources, it’s still subject to interpretation and presentation, which can easily be shifted to fit different needs. So we’re well advised to approach these images with questions. What is actually being shown? What do colors (or their absence) mean? What’s the behavioural significance, if any? And who is being shown? Is this a group of individuals, or one exemplar—and if the latter, is he or she representative of the population, or does the image pit the best in one group against the worst in another? How many times did they use the drug, how heavily, and how long were they abstinent? Could factors other than drug use account for the image? The answers may not be easy to come by. But posing these questions can help overcome gut responses, fostering a fuller, fairer understanding.

In the previous photo, even though the news article claimed to have “conclusively demonstrated severe and multiple disruptions,” the “black holes” don’t indicate dropout of actual brain tissue. They’re a result of threshold-setting: assigning “black vs. colour” at a particular signal value, with the choice of value entirely subjective. This is just one of the many caveats of neuroimaging. In human neuroimaging, for example, actual photographs are rare; more often, images are proxy signals for some biological event that have been digitized and computerized, reconstructed and transformed, and subjected to statistical testing and interpretation. Signals are small, assumptions are many, and at every point, a person intervenes in producing what will ultimately be displayed. The result can sometimes be utter junk—as demonstrated in a study that flashed pictures of human social interactions, and “found” associated brain activation…in a dead fish. Neuroimaging techniques, no matter how brilliant, are removed biological events, so can’t always be assumed to accurately reflect them. Addiction neuroimaging is a tricky area: the field is fraught with political static and agenda. Combine this with the computational limitations of neuroimaging, and emotionally charged headlines can ensue. Ultimately, though, a tool that can visualize the hardware of the mind is extremely valuable in any mental health field. It’s a privilege and a thrill to think of the possibilities ahead.

Zombie Beer Brewed With Real Brains

This brainy brew contains cranberries for carnivorous color and smoked goat brains for grisly flavor.

If you fancy yourself a zombie and would like to drink like one, then Dock Street Brewing Company has a beer for you. Their new brainy brew, Walker, is made with cranberries and real, actual brains.

Being fans of The Walking Dead, the brewing company wanted to pay homage to their favorite mindless hordes with a beer that’s infused with carefully roasted brains – goat brains, of course, since we aren’t real zombies yet – for a savory undead twist. The beer is also brewed with cranberries to give it a bloody hue to really help drinkers get in touch with their inner mindless cannibal.

The beer runs at about 7.2 percent alcohol by volume – about 50 percent more potent than most American beers – meaning it will turn drinkers into brainless, shambling shells of themselves in no time. Geek.com has pointed out that this is possibly the worst beer to drink during a zombie apocalypse, as it can put you in a slumped-over stupor rather quickly and leaves your breath smelling like roasted brains, an aromatic meal that will attract the zombie hordes.

The company is set to premiere their “smartest beer” at their own screening of The Walking Dead finale at the end of this month.