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Number One, International Killer: Alcohol

Alcohol contributes to 2.5 million deaths worldwide a year, making it the number one international killer for 2011, according to the World Health Organization (WHO).  There is also a growing concern over the number of alcohol-related injuries such as car accidents, burns, falls and poisonings, as well as other social and financial tolls such violence, disease, child neglect and job absenteeism.

“Substance abuse disorders profoundly affect our society,” said Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA). In economic terms, alcohol abuse disorders costs the U.S. approximately half a trillion dollars a year. But as Dr. Volkow said, “[Alcohol abuse] is much more insidious, eroding the foundation of human relationships and the established social contract.” (Medical News Today)

A new federal study in the U.S. found that parents are giving their children alcoholic beverages at a much higher rate than most people realize. According to a report from SAMHSA, in the past month alone 200,000 kids were given alcohol by a parent or other adult family member. This is especially dangerous with studies confirming that drinking as a teenager is a potential gateway to alcohol problems in adulthood. In fact, studies show that people who begin drinking before the age of fifteen are six times more likely than those who start at twenty-one to develop an alcohol problem. Parents need to be aware that providing alcohol to children can expose them to an increased risk for alcohol abuse.

The key finding in a recent study regarding the Rutgers Alcohol Problem Index (RAPI), which is widely used to assess adolescent drinking-related problems, found that the more drinking-related problems experienced by an adolescent at the age of eighteen, the greater the likelihood of alcoholism being diagnosed at the age of twenty-five.

Addiction Prevention: Instant Gratification vs. Future Consequences

Addiction prevention programs that emphasize negative future consequences of substance abuse don’t appear to be working.  Essentially, addicts not only value instant pleasure but they also devalue future consequences.  Despite the fact that now more than ever, schools educate students on the risks of substance abuse, the number of cases involving substance abuse disorders continues to climb.

This is also true regardless of television regularly displaying the destructive nature of drug abuse, including its negative consequences and social repercussions while intoxicated (often surrounding celebrity hype) and the harsh rigors of trying to get and stay sober (often shown through popular reality shows such as “Intervention”). And while educational exposure to the negative, long-term repercussions of drug and alcohol use maybe prevent some people from developing addictions, others remain vulnerable. Scientists are starting to understand why this is the case.

People who are at risk for developing substance abuse disorders tend to exhibit a trait called “delay discounting,” which is a cognitive function that involves circuits in the frontal cortex of the brain that stores and manages information necessary to guide behavior. This trait causes the tendency to devalue rewards and punishments that occur in the future. It is often paralleled by “reward myopia,” a tendency to choose immediate rewarding stimuli like drugs or alcohol. This may be one reason why education alone cannot prevent substance abuse. Studies have found that people vulnerable to addiction, who know that drugs are harmful in the long-run, devalue such information and are drawn to the instant rewarding effects of drugs or alcohol. (Medical News Today)

This is also evident with those suffering from substance dependencies who face legal, financial, or health problems. Studies have shown they almost consistently choose instant gratification as long as the reward is sooner, despite whether the future reward is greater. Neuroscientists understand that a major challenge in preventing and treating addiction is the reduced value of future reward, especially once the brain is hijacked by drugs or alcohol.

In a new study, published in Biological Psychiatry, faculty members of Virginia Tech Carilion Research Institute present a strategy that increases the value of future rewards in the minds of substance abuses and those at risk. The researches found that by increasing an individual’s ability to remember decreases the level of discounting future events. The head researcher reiterated, an “improved memory resulted in a greater appreciation of future reward.” (Medical News Today)

The idea for this rehabilitation technique was borrowed from methods used on stroke and traumatic brain injury victims. It involves individuals repeatedly performing working memory tasks. Ultimately, the brain “exercises” were found to promote the functioning of underlying cognitive circuits. When used on substance abuses, this cognitive rehabilitation tool improved working memory and reduced the discounting of delayed rewards. Such a tool may also prove to be invaluable in reaching those most at risk for substance abuse

Prescription Drugs, Binge Drinking Trends: Substance Abuse Surprises?

Substance abuse demographic trends involving prescription drugs and binge drinking may surprise you.  A 2011 report from the Centers for Disease Control and Prevention, the first of its kind, detailed the socioeconomic and racial disparities in an extensive range of health problems.  Some trends remained the same across the board, and fairly obvious, such as “the poor, the uninsured and the less educated tend to live shorter, sicker lives” (New York Times).

For example, obesity and tobacco use were worse among individuals with low incomes, who lacked education or health insurance. While the opposite was true of binge drinking. Consuming more than four drinks for women and five for men in one sitting constitutes binge drinking. The study not only found that binge drinking was one the rise across the board, but that it was more common among those with higher incomes and better education, including college students. However, those with lower incomes, especially among American Indians, tended to consume more alcohol when they binge drink. (New York Times)

Another trend that has changed is prescription drug overdoses kill more people now than illegal drug overdoses (the opposite from 20 years ago). Prescription drug overdose death rates are now higher among White, non-Hispanics than other groups (a trend that shifted in 2002). One reason given for this: “doctors began prescribing stronger painkillers, antidepressants and antipsychotics, more easily obtained by people with health insurance” (New York Times).

This report came in January 2011, the same time the Food and Drug Administration (FDA)  issued new, strict limits on the common ingredient acetaminophen found in prescription painkillers. In 2009, an advisory panel recommended that the FDA remove acetaminophen entirely from painkillers. The FDA has decided to allow prescription painkillers to contain 325 milligrams (about half of what they contain today). Companies have three years to adjust their product’s formula or remove it from the market. More than 200 million painkiller prescriptions are written each for Americans.

Alcoholism in Midlife Increases Risk of Dementia Later

Midlife alcohol consumption (not just alcoholism) is related to the risk of dementia assessed as much as 20 years later, according to a study reported in the December 2010 issue of the Journal of Alzheimer’s Disease.  In particular, individuals who consume large amounts of alcohol are at a greater risk for cognitive impairment later on in life.

Not only was total alcohol consumption analyzed but also drinking patterns. The findings suggest that drinking large amounts at a single occasion, i.e. binge drinking, at least once a month was an independent factor that doubled the risk of cognitive impairment regardless of whether total alcohol consumption was controlled. The same was found for heavy drinking that resulted in passing out. Therefore, the study reports that not only is the amount of alcohol consumed significant in affecting the risks for cognitive impairment, but also the patterns by which alcohol is consumed.

The findings of the study are important in that changes or early symptoms associated with Alzheimer’s disease (the most common form of dementia) can begin as early as two to three decades prior to clinical manifestation of the disease. This means that identifying early risk factors can be imperative for prevention and treatment.

Risk for Alcoholism and Obesity Linked

Researchers at Washington University School of Medicine have  found that those with a higher risk for alcoholism may also be at a higher risk for obesity. The study also found that this correlation between family history of alcoholism and obesity has become more pronounced over the years, which suggested that some of the risks are a function of the environment as well genetics.

The researchers analyzed data from two large alcoholism surveys from the past two decades inclusive of almost 80,000 participants. The study found that individuals with a family history of alcoholism had a greater risk for obesity. This proved even more true for women than men. In 2001 and 2002, women who had a family history of alcoholism were 49 percent more likely to be obese than those without alcoholism in their family history. The risk for obesity also seems to be growing. In the late 1970s in the U.S., 15 percent of the population was obese. By 2004 this percentage had nearly doubled (33 percent).

The research suggests that changes in the food we eat since the 70s and 80s may explain the connection between alcoholism and obesity. Today, many tend to consume higher calories and consist of a sugar, salt, fat combination that appeals to the reward center of the brain, the same brain areas that are effected by alcoholism. The greater availability of these foods may also contribute to the increase.

Alcohol abuse over-stimulates the reward center of the brain until it is unable to support itself with its own chemicals. This leads to anxiety, depression, and greater dependence on the substance. These high-caloric, hyper-palatable foods seem to stimulate the brain in the same way, leading to overconsumption and addiction. However, the researchers noted that not all alcoholics were obese or vice versa. One theory of explanation for obesity in individuals with a family history of alcoholism, is that many may avoid alcohol and turn to food instead, resulting in one addiction instead of another, because of the result the food has on their brain.

The researchers hope that their study will open up a dialogue among addiction therapists, treatment specialists, and those who study obesity. Understanding the correlation between alcoholism and obesity is important in determining methods of prevention and treatment and developing possible advancements in treatment.

Brain and Addiction Link Found in Gene

Researchers at Ohio State University believe they’ve found a genetic variant (characterized by one or both of two identified, tiny gene mutations) that is associated with a more than three times increase in susceptibility to severe cocaine abuse with the risk of fatal overdosing, compared to non-carriers of the genetic variant. (ScienceDaily)

This genetic variant was most common among white people with nearly one in five carrying the genetic variant. Among this group of people, one or both of the genetic variants were found in more than 40 percent of the autopsy brain samples from those known to abuse cocaine. This is compared to only 19 percent of those who lived drug-free and contained one or both of the genetic variants.

It was found that this genetic variant, one or both in combination, affect how dopamine functions in the brain. As we’ve discussed before, dopamine is a key neurotransmitter in the reward center of the brain, as well as numerous, regulatory functions of the central nervous system. Previous studies have shown that cocaine blocks dopamine’s reabsorption, leaving the chemical outside the brain cells and thus creates an artificial “feel-good” sensation.

This study found that in people who carry this genetic variant, the “function of a gene responsible for transmitting dopamine signals in the brain is altered” (Medical News Today). This led scientists to believe that this alteration can send neurotransmitters into a vicious cycle, including the development of cravings for an artificial substance, such as cocaine, that can maintain elevated levels of dopamine in the brain.

The study will soon be published in Neuropsychopharmacology. It has further opened the door to more questions about the involvement of the variant in initial use of the drug, level of cravings, and strength of the overall effect of the trait. It also suggests the need to explore how this variant could affect treatment for other psychiatric disorders involving dopamine.

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