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Cravings Differ Between Alcoholics, Gamblers (8/16/2005)

Alcoholics and people addicted to gambling all experience craving, but not in the same way, UPI reported Aug. 15. Brazilian researchers said that while alcoholic craving is tied to negative emotions, craving for gambling is based on the desire for positive feedback. "We found that alcohol craving was based on the temperament factor responsible for negative emotions, (suggesting) individuals who are especially vulnerable to negative emotions are the ones who will miss alcohol the most when trying to abstain," said lead researcher Hermano Tavares of the University of Sao Paulo. "Conversely, gambling craving correlated to the temperament factor responsible for positive emotions. This suggests that individuals who naturally lack positive emotions and require intense stimuli to experience elation are the ones who will miss gambling the most when trying to abstain." Tavares and colleagues noted that there are two types of craving: physical craving that is related to withdrawal, and memory-based craving, which persists long after withdrawal subsides. The study appears in the August 2005 issue of Alcoholism: Clinical & Experimental Research.

TIP 41: Substance Abuse Treatment: Group Therapy

The guide is designed to aid substance abuse counselors who employ group therapy in the treatment of substance use disorders. TIP 41contains detailed, state-of-the-art information about group therapy modalities, techniques, and practices that are valuable to substance abuse treatment counselors as well as supervisors and trainers of counselors. Tips are consensus documents formulated by non federal clinical researchers, clinicians, program administrators and client advocates who evaluate all relevant clinical and health services research findings. http://store.health.org/catalog/productDetails.aspx?ProductID=16899

Study Reviews Treatment Cost-Effectiveness Findings (4/7/2005)

Researchers affiliated with the Treatment Research Institute at the University of Pennsylvania released a review of treatment cost-effectiveness research in February, "Economic Benefits of Drug Treatment: A Critical Review of the Evidence for Policymakers," Alcoholism & Drug Abuse Weekly reported on March 28. For the full report, visit the Treatment Research Institute website. Researchers analyzed cost-assessment data to determine effective practices for different substance abuse treatment modes, including outpatient and residential treatment, methadone maintenance, and treatment of special populations. The report also includes analysis of the cost-benefits of improved outcomes, using a benefit cost ratio analysis (BCR) of 1 or higher to designate a cost-effective program. Findings included:

• Evidence-based practices achieve clinically significant reductions in alcohol and drug use and improvements in clients' health and social functions
• Residential programs may be more effective than outpatient ones for high-risk populations, although outpatient programs reduce substance use at a lower cost
• Enhanced outpatient programs are more cost-effective than standard ones.
• Brief interventions for clients who use alcohol may be more effective in some settings than in others.
• Prison treatment is cost-effective when combined with post-release aftercare services.

Parkinson's Drugs Increase Addictive Behaviors (7/12/2005)

People given dopamine agonists like pramipexole and ropinirole to battle Parkinson's disease were more likely to gamble compulsively, drink more, increase their spending, and become "hypersexual," researchers said. The Telegraphreported July 12 that researchers from the Mayo Clinic found that some patients who had never gambled before or only gambled occasionally began to gamble heavily after taking the drugs. And of the 11 patients studied, six also developed other addictive problems. One patient lost almost $200,000 gambling in the six months after starting treatment. "It's a very rare side-effect and reversible if you get off the drug," said Eric Ahlskog, who treated the patients involved in the study. "But you have to make the association." In all cases, compulsive gambling stopped within months of drug therapy ending. The research will be published in the Archives of Neurology.

Lack of Physician Training Part of Prescription Drug Abuse (7/8/2005)

Many doctors and pharmacists say that their training in prescribing powerful painkillers and other controlled substances is limited -- a shortcoming that is becoming more acute as misuse of these drugs grows, Newsday reported July 7. A new report from the National Center on Addiction and Substance Abuse (CASA) at Columbia University noted that people who abuse prescription medications can get the drugs from doctors, friends and relatives, or online. About 15 million Americans misused prescription drugs last year, including growing numbers of young people.

But 40 percent of doctors surveyed by CASA said they did not get any formal training on prescribing controlled substances while in medical school, and more than half said they had never been trained to identify prescription-drug abuse or addiction. Similar numbers of pharmacists said they had not received any training on identifying prescription-drug abuse or diversion since they left pharmacy school. CASA also reported that half of physicians said their patients pressured them to prescribe controlled substances, and that three in 10 pharmacists said they do not regularly validate prescribers DEA ID number before dispensing controlled substances.

Study: Fruit Flies Have 'Hangover Gene' (8/12/2005)

A so-called "hangover" gene found in fruit flies seems to increase tolerance for alcohol, which in turn could predispose some to alcohol dependence, Reuters reported Aug. 11. Researchers led by Ulrike Heberlein of the University of California at San Francisco found that only fruit flies that carried a working "hangover" gene developed alcohol tolerance, needing more and more alcohol in order to become intoxicated. The findings illustrate the potential for developing medications to prevent addiction, the authors said. "If humans have a gene that has a function similar to that of 'hangover,' we could interfere with the function of such a gene," said Herberlein. The gene is believed to help the body respond to environmental stress; flies lacking the gene responded more poorly to heat and the presence of damaging free radicals. The study was published in the Aug. 11, 2005 issue of the journal Nature. (Scholz H., Franz M., and Heberlein U. (2005) The hangover gene defines a stress pathway required for ethanol tolerance development. Nature, 436(7052), 845-847.)

Drinking Linked to Upper GI Cancers (8/8/2005)

Cancer of the upper gastrointestinal tract could be caused by drinking, new research suggests. Researchers from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute of Standards and Technology (NIST) said that metabolism of alcohol produces a substance called acetaldehyde, a known carcinogen, which could explain the link between drinking and increased risk of upper GI cancers. "We've long suspected acetaldehyde's role in the carcinogenicity of alcohol beverage consumption, but this study gives us important new clues about its involvement," said Ting-Kai Li, M.D., director of NIAAA. Researchers P.J. Brooks, Ph.D., of NIAAA and Miral Dizdaroglu, Ph.D., of NIST noted that even low levels of acetaldehyde ere enough to produce crotonaldehyde, a toxin known to cause cancer through genetic mutations. The study appears in the journal Nucleic Acids Research. (Theruvathu J. A., Jaruga P., Nath R. G., Dizdaroglu M., and Brooks P. J. (2005) Polyamines stimulate the formation of mutagenic 1,N²-propanodeoxyguanosine adducts from acetaldehyde. Nucleic Acids Research, 33(11): 3513-3520.)

Researchers Discover Mechanism Behind Alcohol-Cancer Link (8/4/2005)

A federal research team has discovered more clues behind the long-suspected role of the carcinogen acetaldehyde in the link between alcohol consumption and some forms of cancer. Researchers at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute of Standards and Technology report that natural compounds called polyamines react with acetaldehyde - which is formed as the body metabolizes alcohol - to generate reactions that damage DNA. This can lead to the formation of cancer. "This work provides an important framework for understanding the underlying chemical pathway that could explain the association between drinking and certain types of cancer," said NIAAA director Ting-Kai Li, M.D. Alcohol consumption has been associated with increased risk of upper gastrointestinal cancer and other cancers. Polyamines, which are essential for cell growth, generally protect DNA from damage. But researchers found that when these compounds react with acetaldehyde, they facilitate its conversion to crotonaldehyde, which has been shown to cause cancer in animals. "We were able to demonstrate that these reactions can take place with acetaldehyde concentrations that have been measured in human saliva during alcohol consumption," said lead NIAAA researcher P.J. Brooks, Ph.D.

Study: Treatment Saves Medicaid Money (7/28/2005)

Medicaid patients who received addiction treatment experienced a 30-percent decrease in their overall medical costs under the program, according to a new study from researchers at Kaiser Permanente. Patients who received treatment through a managed behavioral-healthcare program saw their Medicaid costs fall from an average of $5,402 per year to an average of $3,627 per year, said study author Lawrence Walter of Kaiser's Division of Research. The study also found that Medicaid patients with addiction problems had medical costs that were 60 percent higher than non-Medicaid patients prior to entering outpatient treatment. "Previous studies have shown similar reductions in healthcare costs as a result of providing substance-abuse treatment, but this study also showed that the reductions in medical costs are across all areas, including hospital stays, visits to the emergency room, and medical clinics," said Walter. "The reductions in cost are not because of a shift in costs from one area to another." Researchers compared a group of 197 Medicaid patients with a group of non-Medicaid patients. Each group was tracked for a year before and three years after getting addiction treatment at Kaiser's Vallejo Chemical Dependency Recovery Program in Oakland, Calif. The study was funded by the of the Robert Wood Johnson Foundation's Substance Abuse Policy Research Program. It appears in the July 2005 issue of the Journal of Behavioral Health Services and Research.

Few Americans Diagnosed as Alcoholics (7/25/2005)

Researchers say about 8 percent of Americans are dependent on alcohol, but just .06 percent of health-plan members are diagnosed with alcoholism, Medical News Today reported July 23. Researchers said that the study showed that health plans are doing a poor job of identifying alcohol problems, especially compared to other health conditions. For example, while only about 8 percent of health-plan members with alcohol problems are properly diagnosed, health plans correctly diagnose about 40 percent of people with depression, 65 percent of diabetics, and 70 percent of people with hypertension. Moreover, less than half of those diagnosed with alcohol problems (44 percent) attended any kind of treatment within two weeks of diagnosis. "This project offers concrete evidence of the scale of the challenge to improve the identification and treatment of alcohol dependence among America's workers," said Eric Goplerud, Ph.D., director of the group Ensuring Solutions to Alcohol Problems, which conducted the review of the 2005 eValue8 RFI Initiative that includes data from about 250 U.S. health plans. Goplerud said doctors as well as plan administrators shared blame for the problem. "Imagine discovering an illness that kills about 85,000 people annually, and then imagine that we identify only one in 20 of those people -- even though we have effective treatments that can be administered by primary-care physicians or specialists," he said. "Wouldn't there be an outcry to establish a national approach to improving access to quality care for this disease? Here we have such an illness: alcoholism. Yet we accept low rates of identification and treatment. Our approach to alcohol treatment is unlike what we expect and demand for treatment of diabetes, high blood pressure, asthma or virtually any other health condition." The evaluation was sponsored by the National Business Coalition on Health. The data was presented at an American Medical Association media briefing on "Alcohol Dependence: From Science to Solutions."

Nicotine Addiction, Cognitive Benefits Linked (7/8/2005)

The same area of the brain is involved in both the addictiveness of nicotine and the cognitive benefits some users experience from use of the drug, Reuters reported July 6. Researchers from the CNRS-Pasteur Institute in Paris said that a region of the brain called the ventral tegmental area (VTA) -- part of the natural reward system and the production center for the neurotransmitter dopamine -- plays a role both in addiction and cognitive function. "This is a very critical area for self-administration of nicotine in the brain," said lead researcher Jean-Pierre Changeux. The French researchers studied mice genetically engineered to lack a gene for part of the nicotine receptors in the brain. The mice were found to have mild learning impairments and showed no interest in getting nicotine, unlike normal mice. "When there is a loss of the nicotine receptor then there is a loss of cognitive function in the mouse," Changeux said. However, when the gene was restored, cognitive function rebounded and the mice became interested in nicotine again. "Given the intricacies of the brain, it is striking that reintroduction of a single molecule to just one small area of the brain should so dramatically affect behavior," commented Julie Kauer of Brown University. The results of the study were published in the July 7, 2005 issue of the journal Nature. (Maskos, U., et al. (Jul 7 2005) Nicotine reinforcement and cognition restored by targeted expression of nicotinic receptors. Nature, 436, 103-107.)

Memory Impaired by Smoking, Study Says (5/19/2005)

British researchers say that prolonged, heavy smoking appears to impair long-term memory, the BBC reported May 19. Smokers queried by researchers from five U.K. universities were found to be more forgetful about routine tasks, such as sending out birthday cards, than nonsmokers. Everyday memory, such as misplacing items, also was examined. Heavy smokers among the 700 people surveyed -- those smoking more than 15 cigarettes weekly -- reported making the most memory-related errors. "The study revealed that smokers reported more errors in their long-term memory than nonsmokers, with an additional difference between nonsmokers and heavy smokers," said researcher Tom Heffernan of Northumbria University. "There was also a significant detrimental effect of cigarette use on everyday memory function. For example a typical heavy smoker reported 22 percent more memory-related problems than a nonsmoker, and around 12 percent more problems than those who smoked only relatively a small number of cigarettes." The study appears in the June 1, 2005 issue of the journal Drug and Alcohol Dependence. (Heffernan, T., et al. (2005) Self-rated everyday and prospective memory abilities of cigarette smokers and non-smokers: a web-based study. Drug and Alcohol Dependence, 78(3): 235-241.)

Record Heroin Deaths in Mass. (6/30/2005)

The number of drug overdoses in Massachusetts has risen six-fold over the past 13 years, with narcotics now claiming more lives in the state than traffic accidents, the Boston Globe reported June 29. Last year, 574 people died in drug-related incidents, compared to 521 traffic fatalities statewide. Experts blamed the trend on an influx of cheaper, purer heroin into Massachusetts; in some cases, a bag of heroin can now be purchased more cheaply than a six pack of beer. The drug problem is increasingly invading the middle and upper classes. Nancy Paull, CEO of Stanley Street Treatment & Resources in Fall River agency, said, "Kids are buying OxyContin on the street. But it's quite expensive, and they quickly move to snorting heroin, and that moves to quickly injecting heroin." "We have a major crisis," said Elizabeth Funk, president of Mental Health and Substance Abuse Corporations of Massachusetts. "One would assume that society sooner, rather than later, would be attentive to the situation. We don't put these people on barges and ship them off to the middle of the ocean. They're not going away." Meanwhile, however, Massachusetts lawmakers have been cutting funding for addiction treatment programs, slashing $11 million from its treatment and prevention budget between 2001 and 2004. Statewide, the number of detoxification beds has fallen from about 1,000 to 420 as a result. This year, Gov. Mitt Romney pledged to restore $9.1 million to the state's drug budget.