Summer House

They don’t know each other, but they have much in common:

They’re both from small towns — Masure from St. Johnsbury, Vt., Payne from Hanover, Va. They used to steal beers from their dads before branching out into a variety of drugs.

They have been "clean" for three years, thanks in part to several 12-step program meetings each week. And they’re both preaching what they practice by working for organizations that offer support to people and families struggling with addiction.

Their stories touch upon themes made clear recently by scientists searching for answers about the genesis and treatment of addiction. The questions have plagued researchers for decades, but only in the past several years have they had the tools — such as technology that provides a real-time view of brain function — to unravel them.

The 2004 National Survey on Drug Use and Health found that of Americans 12 and older, nearly 8.4 million were addicted to alcohol and nearly 5 million were addicted to other drugs. About 1.4 million were addicted to both, according to the survey by the federal Substance Abuse and Mental Health Services Administration.

Thanks to advances in neurobiology, "we have enormous knowledge now of what’s going on" in addicts’ brains, says George Koob, professor of molecular integrative neuroscience at the Scripps Research Institute in La Jolla, Calif. Koob, who calls himself an "irrepressible optimist," says he is hopeful that new insights into the mechanisms of addiction will lead to new treatments and reduced suffering.

They might debate the terms used to describe addiction, but top scientists in the field pretty much agree on what it is.

"The inability to stop is the essence of what addiction is," says Nora Volkow, director of the National Institute of Drug Abuse, part of the National Institutes of Health. As Payne, 27, puts it, "my favorite drug was more and all."

That’s not to say that people who can’t make it through the day without latte grandes or Ghirardelli chocolate are addicts, says Volkow, a self-professed "chocoholic" who has pioneered brain-imaging studies of addiction. Caffeine does activate some of the same brain circuits as the drugs of addiction, but only very mildly, she says. Caffeine can be habit-forming, but Starbucks devotees won’t risk jail time or divorce to feed their habit.

Nor is addiction the same as dependence, although the American Psychiatric Association’s diagnostic manual says it is, says Volkow, who’s pushing to drop that wording. "Addiction is much harder to treat. Everybody given an opiate (such as morphine) will become physically dependent, but not everybody will become an addict."

They don’t know each other, but they have much in common:

They’re both from small towns — Masure from St. Johnsbury, Vt., Payne from Hanover, Va. They used to steal beers from their dads before branching out into a variety of drugs.

They have been "clean" for three years, thanks in part to several 12-step program meetings each week. And they’re both preaching what they practice by working for organizations that offer support to people and families struggling with addiction.

Their stories touch upon themes made clear recently by scientists searching for answers about the genesis and treatment of addiction. The questions have plagued researchers for decades, but only in the past several years have they had the tools — such as technology that provides a real-time view of brain function — to unravel them.

The 2004 National Survey on Drug Use and Health found that of Americans 12 and older, nearly 8.4 million were addicted to alcohol and nearly 5 million were addicted to other drugs. About 1.4 million were addicted to both, according to the survey by the federal Substance Abuse and Mental Health Services Administration.

Thanks to advances in neurobiology, "we have enormous knowledge now of what’s going on" in addicts’ brains, says George Koob, professor of molecular integrative neuroscience at the Scripps Research Institute in La Jolla, Calif. Koob, who calls himself an "irrepressible optimist," says he is hopeful that new insights into the mechanisms of addiction will lead to new treatments and reduced suffering.

USA Today — They might debate the terms used to describe addiction, but top scientists in the field pretty much agree on what it is.

"The inability to stop is the essence of what addiction is," says Nora Volkow, director of the National Institute of Drug Abuse, part of the National Institutes of Health. As Payne, 27, puts it, "my favorite drug was more and all."

That’s not to say that people who can’t make it through the day without latte grandes or Ghirardelli chocolate are addicts, says Volkow, a self-professed "chocoholic" who has pioneered brain-imaging studies of addiction. Caffeine does activate some of the same brain circuits as the drugs of addiction, but only very mildly, she says. Caffeine can be habit-forming, but Starbucks devotees won’t risk jail time or divorce to feed their habit.

Nor is addiction the same as dependence, although the American Psychiatric Association’s diagnostic manual says it is, says Volkow, who’s pushing to drop that wording. "Addiction is much harder to treat. Everybody given an opiate (such as morphine) will become physically dependent, but not everybody will become an addict."

(HealthDay News) — Drinking and alcohol dependence has increased substantially among women, particularly white and Hispanic women born since 1945, new study finds.

Alcohol use and dependency appeared to remain stable for men, while young Americans report having more lifetime alcohol problems than older Americans, despite having had less time to develop issues with drinking.

The findings were published in the May issue of Alcoholism: Clinical and Experimental Research.

"We found that for women born after World War II, there are lower levels of abstaining from alcohol, and higher levels of alcohol dependence, even when looking only at women who drank," the study’s corresponding author, Richard A. Grucza, an epidemiologist at Washington University School of Medicine, said in a prepared statement. "However, we didn’t see any significant tendency for more recently born men to have lower levels of abstention or higher levels of alcohol dependence."

The researchers’ findings came from analyzing two large, national surveys conducted 10 years apart (1991-1992 and 2001-2002). The polls compared lifetime alcohol-use rates from the same age groups and demographics.

The "closing gender-gap in alcoholism" may be due to higher levels of problems facing women, while men have been more or less steady in their levels of dependence, he said.

"Clearly, there were many changes in the cultural environment for women born in the ’40s, ’50s and ’60s compared to women born earlier," Grucza said. "Women entered the work force, were more likely to go to college, were less hampered by gender stereotypes, and had more purchasing power. They were freer to engage in a range of behaviors that were culturally or practically off-limits, and these behaviors probably would have included excessive drinking and alcohol problems."

Shelly F. Greenfield, associate clinical director of the Alcohol and Drug Abuse Treatment Program at McLean Hospital, added to Grucza’s assessment.

"One possible explanation is that between 1934 and 1964, the social acceptability of women’s drinking increased. As it was more socially acceptable for women to drink, a greater number of them became drinkers. Because women have a heightened vulnerability to the effects of alcohol — that is, greater blood alcohol levels at similar doses of alcohol — we may therefore see a concomitant rise in alcohol dependence among those who ever drank."

Another potential factor: immigrants arriving to America from cultures with more conservative values about drinking tend to stick with their native cultural norms, but their children are more likely to follow comparatively lax U.S. norms regarding alcohol.

"We can think of U.S. culture as having been traditionally dominated by white men," added Grucza. "As women have immigrated into this culture, they have become acculturated with regard to alcohol use."

He said the added barrier of race may be what is keeping black women, who still have the lowest rates of drinking among the demographic groups looked at, from adopting the alcohol-use standards of the dominant U.S. culture.

Greenfield suggested that targeting females with gender-specific prevention programs might lower drinking rates or delay when drinking begins, which could help prevent later alcohol problems.

"It would also be helpful to educate women about the gender differences in metabolism of alcohol, and the associated heightened female vulnerability to alcohol’s adverse health consequences at lower doses than men," she said.

InfoPackets.com — Major recovery organizations have been using the Internet to help individuals recovering from drug and alcohol addiction. An increasing number of support groups are springing up all over the web with one goal: to provide online, 24/7 assistance to people recovering from some form of substance abuse.

According to the U.S. Department of Health and Human Services, almost 2 million people this year will find themselves entering some kind of rehabilitation for abuse of various drugs or alcohol. In the past 70 years or so, these alcoholics and addicts would have left various rehabilitation institutions to then begin a lifetime of meetings in church basements with fellow addicts or alcoholics, there to find the support and encouragement to continue their life clean and sober.

Typically, the online venues focus on the 12-step recovery approach — the recovery program outlined by Bill Wilson and Bob Smith, founders of Alcoholics Anonymous. It’s a popular program and, it seems, there is now a 12-step program tied to every possible substance abuse or behavior, including Nicotine Anonymous. Instead of holding daily or weekly meetings however, more and more of these 12-step groups are turning their attention to providing online chat, web forum, and list server-based recovery groups. The Internet is being used to connect similarly afflicted individuals and groups from all over the world. Over the world wide web, recovery meetings are no longer of an hour’s duration in a church basement, groups now meet for 24 hours a day with members checking in and out at will or as needed.

Alcoholics Anonymous the oldest of the recovery groups, now offers meetings using email list servers, VoIP, and chat. AA provides online meetings in 33 different countries and hosts them in more than 10 different languages!

Narcotics Anonymous has more than 20 internationally accessible email meetings and Cocaine Anonymous offers 6 internationally accessible email meetings.

Of course, for every benefit of online meetings, there are also some risks. The use of chat protocols, for example, opens up a portal to the user’s PC that may expose them to risk of being hacked. Email-based list servers also pose the problem of how to remain anonymous when the entire virtual room can see your email address.

There are also hazards from various unscrupulous recovery organizations that prey on individuals in early recovery or their families. Over the Internet, they seem like legitimate organizations, but they are not always. As with most Internet-based activities, various fraud, email harvesting, and identity theft schemes abound. But even in those cases, Internet-based solutions emerge. One organization, All Addictions Anonymous Watch, for example, focuses on keeping a watchful eye on some of the less scrupulous efforts to exploit recovering individuals.

Exploiting Internet technology may prove to be a great boon to people trying to shake addictions. It has truly become Addiction Recovery 2.0. Nonetheless, family members and recovering individuals would be wise to stick to the best known recovery organizations (e.g AA, NA, CA) and, if they choose to participate online, they should get a Yahoo!, Gmail, or Hotmail mailbox using a pseudonym to keep themselves truly anonymous.

NEW YORK (Reuters Health) - Young adults who abuse amphetamines may be raising their risk of suffering a heart attack, a new study shows.

Texas researchers found that among more than 3 million 18- to 44-year- olds hospitalized in their state between 2000 and 2003, those who were abusing amphetamines were 61 percent more likely than non-users to be treated for a heart attack.

What’s more, the rate of amphetamine-linked heart attacks rose by 166 percent over the 4-year study period. That compared with a 4-percent rise in cocaine-related heart attacks, the researchers report in the journal Drug and Alcohol Dependence.

"Most people aren’t surprised that methamphetamines and amphetamines are bad for your health," lead researcher Dr. Arthur Westover said in a statement.

"But we are concerned because heart attacks in the young are rare and can be very debilitating or deadly," added Westover, an assistant professor of psychiatry at the University of Texas Southwestern Medical Center at Dallas.

Amphetamines stimulate the central nervous system and some are used to treat attention-deficit hyperactivity disorder, or ADHD. But they are also frequently used illegally; one potent form of amphetamine, methamphetamine, is a growing problem in many U.S. cities.

Cases of heart attack in young people have been linked to amphetamine abuse before, but the current study appears to be the first large- scale look at the epidemiology of the problem.

Westover and his colleagues used a statewide database to examine information on more than 3.1 million 18- to 44-year-olds discharged from Texas hospitals between 2000 and 2003. Overall, 11,011 of these patients (0.35 percent) were treated for a heart attack.

The database also contained information on whether a patient had been diagnosed with any type of drug-abuse problem. The researchers found that patients with a diagnosis of amphetamine abuse or dependence were at increased risk of suffering a heart attack.

Amphetamines have various effects that could precipitate a heart attack, Westover and his colleagues point out. The drugs are well known to speed up heart rate and blood pressure, but they can also trigger spasms in the heart arteries and promote blood clotting.

In people who already have "plaque" deposits in their heart arteries, amphetamines may cause a plaque to rupture, which can then lead to a heart attack.

Besides the risk to individual amphetamine users, Westover said, "we’re also concerned that the number of amphetamine-related heart attacks could be increasing."

"We’d rather raise the warning flag now than later," he added. "Hopefully, we can decrease the number of people who suffer heart attacks as the result of amphetamine abuse."

New York Times — From “Scarface” to “Miami Vice,”Florida’s drug problem has been portrayed as the story of a single narcotic: cocaine. But for Floridians, prescription drugs are increasingly a far more lethal habit.

An analysis of autopsies in 2007 released this week by the Florida Medical Examiners Commission found that the rate of deaths caused by prescription drugs was three times the rate of deaths caused by all illicit drugs combined.

Law enforcement officials said that the shift toward prescription-drug-abuse, which began here about eight years ago, showed no sign of letting up and that the state must do more to control it.

“You have health care providers involved, you have doctor shoppers, and then there are crimes like robbing drug shipments,” said Jeff Beasley, a drug intelligence inspector for the Florida Department of Law Enforcement, which co-sponsored the study. “There is a multitude of ways to get these drugs, and that’s what makes things complicated.”

The report’s findings track with similar studies by the federal Drug Enforcement Administration, which has found that roughly seven million Americans are abusing prescription drugs. If accurate, that would be an increase of 80 percent in six years and more than the total abusing cocaine, heroin, hallucinogens, Ecstasy and inhalants.

The Florida report analyzed 168,900 deaths statewide. Cocaine, heroin and all methamphetamines caused 989 deaths, it found, while legal opiods — strong painkillers in brand-name drugs like Vicodin and OxyContin — caused 2,328.

Drugs with benzodiazepine, mainly depressants like Valium and Xanax, led to 743 deaths. Alcohol was the most commonly occurring drug, appearing in the bodies of 4,179 of the dead and judged the cause of death of 466 — fewer than cocaine (843) but more than methamphetamine (25) and marijuana (0).

The study also found that while the number of people who died with heroin in their bodies increased 14 percent in 2007, to 110, deaths related to the opioid oxycodone increased 36 percent, to 1,253.

Florida scrutinizes drug-related deaths more closely than do other states, and so there is little basis for comparison with them.

It has also witnessed several highly publicized cases in recent years that have highlighted the problem. Only last year, an accidental prescription drug overdose killed Anna Nicole Smith in Broward County.

Still, the state has lagged in enforcement. Thirty-eight other states have approved prescription drug monitoring programs that track sales. Florida lawmakers have repeatedly considered similar legislation, but privacy concerns have kept it from passing.

As a result, federal, state and local law enforcement officials say, Florida has become a source of prescription drugs that are illegally sold across the country.

“The monitoring plan is our priority effort, but that is not enough,” William H. Janes, the Florida director of drug control, said in a statement accompanying the study. He said Florida was also looking at ways to curb illegal Internet sales and to encourage doctors and pharmacists to identify potential abusers.

Some local police departments have taken a more novel approach.

In Broward County on May 31, deputies completed a “drug takeback” in which $5 Wal-Mart, CVS or Walgreens gift cards were distributed to 150 people who cleaned out their medicine cabinets and turned in unused drugs in an effort to keep them out of young people’s hands.

“The abuse has reached epidemic proportions,” said Lisa McElhaney, a sergeant in the pharmaceutical drug diversion unit of the Broward County Sheriff’s Office. “It’s just explosive.”

Utah — “Methamphetamine addiction has the worst long-range organic effect on the brain of any drug,” said Glen Hanson, University of Utah Addiction Center director.

Hanson’s blunt comment defines extent of the the public health problem in meth-damage control in Utah.

He was speaking at an all-day meth workshop before 30 participants; family members, caregivers and health care professionals in Roosevelt on June 21.

Addiction of any kind is a learned repetitive behavior, but meth is the worst, ” explained Hanson, “It alters the brain biology in ways similar to Alzheimer’s or Parkinson’s disease.”

Why would anyone choose to damage their brain to such a degree? The answer, because “it feels good,” may be the best an addict can offer after treatment.

Simplistic as it sounds, it is not wrong. Meth over-stimulates the “feel-good” portion of the brain and can severely damage a person’s cognitive abilities.

“The brain is a network of 100 billion cells that transmit information by making 2,000 connections individually,” Hanson said, telling the group why an addict’s ability to communicate has been compromised.

“Stimulated brain cells respond by releasing dopamine to anything that feels good” he continued. “Over-stimulated brains release too much dopamine. Then the free radicals that are chemically abundant in dopamine will eventually destroy portions of the brain.”

Meth stimulates the release of dopamine in excess. The more an addict uses the more they crave. It affects the cognition system in the brain by “turning-off” the prefrontal cortex.

As a consequence, meth addicts loose inhibitory control, tending to act on impulse rather than reason. They overreact to situations, tending toward rage.

This is partly due part to the “damage to the orbitofrontal cortex which ultimately inhibits saliency,” said Hanson. “The addict becomes motivated most by getting and using meth over anything else.”

It fouls up the meth addict’s ability to appreciate consequences like taking care of their children, themselves or being cognizant of others.

“Meth addicts may steal from or abuse their family members with little conscience,” the researcher explains. “All they think of is the drug, because the reward portion of their brain is on all the time.”

Hanson referred to the amygdala reward-region of the brain, which processes memory and emotional control. Damage to the region and the adjacent hippocampus region leaves the addict agitated and often aggressive.

Once these areas are damaged the memory portion of the addict’s brain often fails to recover even with treatment.

“Rehabilitating cognitive systems requires exercise,” explained the researcher. “Sometimes that means establishing new pathways in the brain around damaged portions that will never return.”

“Treatment is lengthy,” he continued, “requiring five to seven months for brain function to stabilize and restore saliency. It’s hardest for meth addicts because their familial support systems are often irreparably damaged. They’ve hurt the very people they need most.”

In the end, there are successful treatments to re-develop cognitive skills through mental exercise. One way, Hanson explained is through literacy education, which seems to help re-establish cognitive functions.

So, why with all this wreckage would anyone choose to use meth? Hanson’s research suggests that there is a strong sociocultural component contributing to the meth scourge in Utah.

“Meth abuse demographics indicate that it is the primary drug of choice among women,” he explained. “Thirty-seven percent of all women in treatment are addicted to meth. Men use it too, but represent fewer addicts in treatment than women.”

Some women are attracted to meth as it is readily available, cheap and long-lasting in effect. Others discover more energy, weight loss or help with social inhibitions through meth abuse.

“In Utah, there’s a sociocultural tendency of women toward perfection,” said Paul Smith, eastern Regional Director of the Division of Child and Family Services. “Perfect wife. Perfect mother. Perfect beauty. Too much pressure toward perfection drives the social component of meth abuse.”

“Whatever the cause, abuse is only part of addiction,” Hanson said. “Only 15 percent of users become severely addicted, which means 85 percent of users are out there managing their drug use.”

Why people become addicted may, in part, be genetic. For example, researchers found that many women in treatment suffer from other repetitive disorders like smoking or alcoholism.

The most interesting connection was re-occurrence of attention deficient-hyperactivity disorder. The familial connection of ADHD or alcoholism may include a predisposition toward drug addiction among family members.

There’s also the social aspect of addiction. Meth tends to stay in the family. A documentary shown at Saturday’s seminar showed women frankly admitting that, “My daughter introduced me to meth and then I gave it to my sister, and so on.”

Hanson notes that addictions like alcoholism re-occurs in families, but there is hope. Children removed from addictive families show no greater addiction rates than children from non-drug abuse families.

However, children left in addictive families are almost certainly going to experiment with drugs. Addictions, particularly those with long-term treatment requirements like meth are a burden on Utah society.

“Forty-seven percent of women in treatment for meth addiction have children,” Hanson continued. “Worse still, 45 percent of female meth addicts end up in prison. Incarcerated women cost the state $30,000 each and an additional $33,000 for each child placed in foster care. All totaled, jailed addicts cost the state about $100,000 a year.”

Treatment, on the other hand, costs the state about $15,000 per person. More recently, the treatment alternative has become policy in the criminal justice system of Utah. The effort is to stop the revolving door of prison addicts.

“New strategies for treatment are highly successful, but the addict must remain in rehabilitation,” said Hanson. “Judges are learning that success requires mandated, long-term compulsory treatment. I guess they figured that success means more taxpaying Utahns.”