Sober N Clean

Nearly half of young adults may suffer from a mental disorder such as alcohol abuse, depression and anxiety, and nearly one in five suffer from a serious personality disorder.

But according to new research published yesterday, fewer than a quarter of those young adults who do have mental concerns seek treatment for them.

And to check on whether such mental health concerns
might be triggered by attending college or not, the researchers compared those attending and not attending college and found similar rates of psychiatric illnesses among the two groups. This suggests that the transition from adolescence to adulthood can trigger the onset of a mental health problem regardless of setting.

The researchers analyzed data from over 5,000 young adults aged 19 to 25 years old from the
National Epidemiologic Survey on Alcohol and Related Conditions. Carlos Blanco, M.D., Ph.D., of the New York State Psychiatric Institute and Columbia University, and his colleagues analyzed the data to compare the mental health of those enrolled in college at least part-time with those not attending college during the previous year.

The researchers interviewed and assessed for psychiatric disorders those attending (2,188) or not attending (2,904) college during the previous year.

A total of 45.8 percent of college students and 47.7 percent of young adults not in college met the criteria for at least one psychiatric disorder.

The most common disorders in college students
were alcohol use disorders (20.4 percent) and personality disorders (17.7 percent), whereas those not in college most frequently met criteria for personality disorders (21.6 percent) and nicotine dependence (20.7 percent).

College students were less likely to have a diagnosis of drug use disorder, nicotine dependence or bipolar disorder and were less likely to have used tobacco. However, their risk of alcohol use disorders was significantly greater.

Treatment rates were low for all psychiatric disorders. College students were significantly less likely to receive treatment for alcohol or drug use disorders than those not in college.

“In view of the high prevalence and low rate of treatment of alcohol use disorders in college students, greater efforts to implement screening and intervention programs on college and university campuses are warranted,” the authors write. “The centralized delivery of campus student health services might offer an advantageous structure for carrying out such screening and interventions.”

Overall, the authors note, the rate of psychiatric disorders is high among young adults, who are at a vulnerable stage of development.

“The vast majority of disorders in this population can be effectively treated with evidence-based psychosocial and pharmacological approaches,” they conclude.

“Early treatment could reduce the persistence of these disorders and their associated functional impairment, loss of productivity and increased health care costs. As these young people represent our nation’s future, urgent action is needed to increase detection and treatment of psychiatric disorders among college students and their non–college-attending peers.”
_________
source: Psychcentral.com

Hydrocodone addiction is a growing crisis in the United States. While illegal drugs like cocaine, marijuana, methamphetamine, and heroin remain in the headlines many individuals may be surprised to know that hydrocodone addiction could lurk right behind them as one of the most widely-abused drugs of addiction. In fact, the federal Drug Enforcement Administration believes hydrocodone may be the most abused prescription drug in the country. Nationwide, its use has quadrupled in the last ten years, while emergency room visits attributed to hydrocodone abuse soared 500 percent.

Hydrocodone is a narcotic that can produce a calm, euphoric state similar to heroin or morphine--and despite such important and obvious benefits in pain relief, evidence is pointing to chronic addiction. Pure hydrocodone is a Schedule II substance, closely controlled with restricted use. But very few prescription drugs are pure hydrocodone. Instead, small amounts of hydrocodone are mixed with other non-narcotic ingredients to create medicines like Vicodin and Lortab. This means they can be classified under Schedule III with fewer restrictions on their use and distribution.

Vicodin, Lortab--and more than 200 other products that contain hydrocodone--are regulated by state and federal law. But they are not controlled as closely as other powerful painkillers. The lack of regulation makes them vulnerable to widespread abuse and addiction through forged prescriptions, theft, over-prescription, and "doctor shopping." Hydrocodone pills have been sold for $2 to $10 per tablet and $20 to $40 per 8 oz bottle on the street.

Subject to individual tolerance, many medical experts believe dependence or addiction can occur within one to four weeks at higher doses of Hydrocodone. Published reports of high profile movie stars, TV personalities and professional athletes who are recovering from Hydrocodone addiction are grim testimony to its debilitating effects.

Hydrocodone is structurally related to codeine and is approximately equal in strength to morphine in producing opiate-like effects. The first report that hydrocodone produced a noticeable euphoria and symptoms of addiction was published in 1923; the first report of hydrocodone addiction in the U.S. was published in 1961.

Every age group has been affected by the relative ease of hydrocodone availability and the perceived safety of these products by professionals. Sometimes seen as a "white-collar" addiction, hydrocodone abuse has increased among all ethnic and economic groups. DAWN data demographics suggest that the most likely hydrocodone abuser is a 20-40 yr old, white, female, who uses the drug because she is dependent or trying to commit suicide. However, hydrocodone-related deaths have been reported from every age grouping.

Examples of how severe Hydrocodone addiction has become:

An estimated 7 million dosage units were diverted in 1994 and over 11 million in 1997.
In 1998 there were over 56 million new prescriptions written for hydrocodone products and by 2000 there were over 89 million.
From 1990 the average consumption nationwide has increased by 300%. In the same period there has been a 500% increase in the number of Emergency Department visits attributed to hydrocodone abuse with 19,221 visits estimated in 2000.
In 1997, there were over 1.3 million hydrocodone tablets seized and analyzed by the DEA laboratory system.
_________
source: drug-addiction.com

When it comes to addiction, two schools of thought dominate: 1) Addiction is all in the mind of the addict, and 2) Addiction is an identifiable and very real disease.


What if both are true?

Enter: The Secret Disease of Addiction: A Dis-ease Which Tells Us it Isn’t o­ne, by Jane Allen, a recovering addict and co-founder of Affinity Lodge, a rehabilitation center producing success rates far above most facilities. Allen offers a provocative and controversial explanation of addiction based o­n it starting and ending in the brain, and why addiction is an acquired disease.

Unlike virtually any ‘theory’ put forth o­n the topic of alcohol and drug addiction, Allen posits that the disease of addiction is created and acquired by over-use of mood-altering substances.

The Secret Disease of Addiction, inspired and influenced by Allen’s mentor and co-founder of Affinity Lodge, John Gillen, explains in clear, simple language the psycho-biology of addiction by blending scientific knowledge with personal experiences.

The underpinnings of Allen’s philosophy o­n addiction have led to amazingly successful outcomes at Affinity Lodge, with a recovery rate far exceeding most programs.

“Addiction is an acquired disease, and this is difficult for most people to understand,” says Allen. “But when a person does come to understand it, stable recovery becomes much more possible.”

Although Allen’s program for stable and enduring recovery shares some similarities with Alcoholics Anonymous in terms of a heavy focus o­n God and spirituality, its premise – true understanding of the disease and self-empowerment rather than ‘outside’ dependency – differs substantially. Allen’s book outlines a process which starts with an admission that addicts are powerless in fighting the disease o­n their own, but its focus is o­n educating the addict to fully understand the physical, mental and spiritual aspects of recovery, supported by science.

“Addiction has a ‘starting point,’” notes Allen. “It is not solely a genetic predisposition to addiction; there are emotional, psychological and physical reasons why Happy Hours often equate to sad years, and why we turn to mood-altering substances to self-medicate.”

The Secret Disease of Addiction covers topics including:

Why addiction is a ‘disease which tells us it is not a disease’
Why addiction is in fact a disease caused by over-use of alcohol or drugs
The ‘party effect’ which often happens in adolescence, and why the ‘buzz’ of substances causes some to become addicted, while others do not.
The biological ‘need for relief’
The ‘geometric’ progression of addiction – from tolerance to dependency
Why addiction is a disease of stress, created by lifestyles and environment

“My book is a non-AA book which openly discusses and acknowledges the importance of God and spirituality,” adds Allen. “88% of people in AA don’t really ‘get it,’ and o­nly 5% of those who do stay o­n the program. Understanding the multi-faceted underpinnings of addiction dramatically improves success statistics; I know because I’ve lived it and see it in our program.”
__________
About the author
Jane Allen was raised in a middle class family and moved out at the age of 19. After a serious back injury led to a 10+ year addiction to painkillers, Allen went to several recovery and counseling programs with no long term success. After meeting John Gillen, Allen was able to control her addiction. She is currently an addiction specialist at Affinity Lodge located outside of London.
_____
source: Tristate Observer, http://www.tristateobserver.com

More than a third of people who present at Sydney emergency departments after smoking cannabis are violent and half have mental health problems such as severe anxiety and suicidal thoughts, shattering the image that dope smokers are relaxed and sleepy, researchers have found.

The data, collected by the National Cannabis Prevention and Information Centre, at the University of NSW, indicates that cannabis users can be as aggressive as crystal methamphetamine users, with almost one in four men and one in three women being violent toward hospital staff or injuring themselves after acting aggressively. Almost 12 per cent were considered a suicide risk.

"It flies in the face of what people typically think of cannabis - that it is a natural herb that makes people mellow," the centre's director, Professor Jan Copeland, said yesterday.

"The reality is that it can make people highly agitated and trigger acute episodes of anxiety."

She said the study, which covered two hospitals from 2004 to 2006, revealed that more than 9 per cent of cannabis users had depression or bipolar disorder, 5 per cent had schizophrenia and 4 per cent had paranoia and a history of self-harm.

"It's the first time we have ever gathered this data and it is highly surprising. It's apparent that we need a higher level of early intervention to pick up these problems before they get to the emergency department," Professor Copeland said.

The head of emergency at St Vincent's hospital, Gordian Fulde, said yesterday most people still believed marijuana was a soft drug, but "the old image of feeling sleepy and having the munchies after you've had a smoke is entirely inappropriate for modern-day marijuana".

"The grass we smoked in the '60s could have been lawn clippings compared to this completely different breed of nasty cat," he said.

"With hydroponic cannabis, the levels of THC [the active ingredient tetrahydrocannabinol] can be tenfold what they are in normal cannabis so we are seeing some very, very serious fallout."

Cannabis use was soaring among young professionals in the city and inner west, Dr Fulde said, but users rarely needed sedation.
________
source: http://www.theage.com.au/

Local homes help struggling veterans

Wausau's John Blahuta is a 60-year-old Vietnam-era Army veteran who for most of his life worked as a corporate tax preparer. When he was laid off from his job five years ago, he expected to be able to find work quickly.

"I come from a very hardworking family, a strong work ethic," he said. "I'd rather work than get a handout."

But Blahuta did not find a new job. He was told he was "overqualified" for the clerical and retail jobs for which he applied, he said. His bills began to go unpaid, and more bills were added to those. Eventually he lost most of his possessions and his home.

"I don't have alcohol (addiction)," he said. "I don't have drugs, I don't have mental illness. But I am a homeless veteran."

Memorial Day is a day set aside to honor fallen American veterans -- those who have died in war. But there's another group of fallen vets -- those who face tremendous challenges when their service to the country ends.

Some, like Blahuta, may simply fall on hard times. Many others face substance abuse or mental health issues. Nearly a third of veterans coming home from Iraq and Afghanistan have been diagnosed with some form of mental illness.

"It's bad when all these men and women go over there and serve their country, and then they come back and ... wind up living in the streets or under bridges," said Kelly Ferguson, 44, a house manager at Wausau's Randlin Adult Care Family Homes, which provides transitional housing for veterans and others in need.

Blahuta, who came to Randlin Homes as a resident in October, has been able to apply his professional experience within the organization, and in March he was elected treasurer of Randlin's board of directors.

Rebecca Epperson, 51, of Wausau is another house manager at Randlin Homes, as well as a Navy veteran who served during Vietnam. She came to Randlin as a resident after a period of homelessness, and she has faced physical and mental health issues. But she said the biggest problem among the homeless veterans she sees is substance abuse, particularly alcoholism.

"They can get a job, and they'll have that job for awhile," she said. "Then they start drinking, they relapse. They lose their job. They lose their home, they lose the friends that they just got. They start that cycle all over again. We're here to break that cycle."

Linda Larson Schlitz, who co-founded Randlin Homes with her husband, Ralph, said the organization's environment is crucial to its mission.

"We provide a family environment of people who care about them, who remember their birthdays and celebrate their sobriety days," Larson Schlitz said.

About 25 percent of Randlin's residents are not veterans. Tanya Throop, 33, is Blahuta's daughter, and she has struggled with mental illness, substance abuse and homelessness in her own life. Residency has provided her with structure and help with everything from taking her medications on schedule to learning how to make crafts.

Throop also works on painting plaster figurines in part as a way to learn patience and attention to detail. The homes work with other residents, both veterans and non-veterans, to develop skills that can be applied to other parts of their lives.

The issue of how society should provide for veterans is an ongoing discussion, and organizations like Randlin Homes are only one part of it. In late May, the U.S. Senate passed a bill that would expand educational benefits for veterans of wars in Iraq and Afghanistan, making them eligible for the equivalent of full tuition at state universities following their service.

Expanded educational opportunities and job training were other subjects mentioned by Randlin staff, including Christine Oestreich, 30, of Wausau, a Navy veteran of the Afghanistan war.

"Places like the (Marathon County) Job Center give opportunities to veterans who are actively looking for jobs," Oestreich said.

Another subject that came up again and again in conversations with residents and staff was the distance most veterans must travel to get medical care. The outpatient clinic for veterans in Wausau has a long waiting list, and is not equipped to treat some conditions. Many are forced to travel to Madison or Tomah to get treatment.

As organizations like Randlin Homes try to meet the needs of homeless veterans in Wausau, Larson Schlitz said veterans are also working in her organization to help one another.

"We couldn't do it if we didn't have veterans helping other veterans," she said.
_________
source: Wausau Daily Herald

Whether their beverage of choice is a full-bodied red or an ice-cold Blue, Canadians love to drink. In fact, according to the most recent figures from the Canadian Centre on Substance Abuse (CCSA) in Ottawa, alcohol is the psychoactive substance of choice for nearly 80 per cent of the population over the age of 15. Most people tend to drink moderately—consuming one or two drinks a day, doctors say, is healthy. But others frequently drink a very unhealthy four or five drinks at a sitting. The CCSA puts that number at about seven per cent of the population, or 2.3 million people. “And if that doesn’t appear high,” says Doug Beirness, a senior CCSA analyst and a scientist, “the problems caused by those people are huge.” Not only do alcoholics lose jobs and destroy relationships, they cost our medical system untold millions in the treatment of alcohol-related diseases. Alcohol, say experts, goes to every cell in the body and can result in neurological and gastrointestinal disorders, high blood pressure and a whole raft of psychiatric illnesses including depression.

In Canada, certainly, selling alcohol is a booming business. During the fiscal year ending in March 2006, beer and liquor stores and their agencies reported sales of more than $17 billion worth of alcoholic products, up more than $1 billion in just two years. Says Dr. Peter Selby, the clinical director of addiction programs at the Centre for Addiction and Mental Health in Toronto, “Does that mean more people are drinking or people are drinking more? It could be both.”

Exactly who is drinking and how much, however, is a tricky thing to document, especially since any sort of survey depends on honest answers from the drinkers themselves. According to the latest Canadian Addiction Survey, released in 2004, those most likely to have a drinking problem fall into a number of different categories. Overall, people who are male, young, divorced, separated or widowed, have a good education and a high income, are likely to drink, but those who abuse alcohol tend to be less educated, young singles. Still, those findings aren’t hard and fast—they are “self-reported,” Beirness says.

This spring, Health Canada began a new Canadian Alcohol and Drug Use Monitoring Survey (CADUMS). It relies on questions and answers over the telephone to determine the prevalence, incidence and frequency of alcohol, cannabis and other drug and substance use in the Canadian population aged 15 years and older in order to measure the extent of associated harms. Will the 10,800 respondents answer honestly? “Sales data tells us more alcohol is being sold than people tell us they are drinking,” says Beirness. “And people are not buying it and pouring it down the drain.”

One thing experts are sure of, though, is that alcoholism is being under-diagnosed by Canadian doctors, probably because it’s a hard subject to raise. “The stigma has gone down for depression,” Selby says. “But doctors don’t feel comfortable about asking their patients how much they drink for fear of offending them.” This is unfortunate, Selby adds, because “there is good evidence that a brief intervention by a physician can help people who are drinking too much cut down.” In this Selby has support from the CEO of the most famous addiction treatment centre in the world, the Betty Ford Center in Rancho Mirage, Calif., Dr. Garrett O’Connor.

O’Connor points to a 2002 Columbia University study that said turning to a family doctor may be “a missed opportunity.” Says O’Connor, “It’s a terrible tragedy. It’s been shown in England that even a 10- to 15-minute chat with a patient can be almost as good as treatment in terms of helping people to stop drinking and stay sober for up to 18 months.” O’Connor himself is a recovering alcoholic, and, he says, the only person who ever suggested he might have a problem was a dentist. Plus, O’Connor says, many alcoholic patients are ambivalent—it’s like they want to get help and not get help at the same time.

But when it comes to stopping alcoholism in its tracks, experts say, someone in the medical profession should catch it in the very young before it becomes entrenched. Increasingly, studies are showing that some children as young as 11 or 13 are already alcoholics, and that the younger a child is when he begins to drink, the higher his risk of becoming addicted. It may be that adolescent drinking actually alters the growing brain. Says Selby: “That’s why a lot of people say if you can delay consumption until early adulthood, you can reduce the risk. Maybe the developing brain just learns more quickly.” Or maybe the brain’s pathways are altered.

A recent study done at Wake Forest University in Winston-Salem, N.C., on brain tissue samples taken from the superior frontal cortex (part of the brain that involves feelings of desire and reward) in chronic alcoholics post-mortem reveals that changes occur at the molecular level. In other words, the brain was irreparably altered. Even that is not wholly new. As far back as 2000, researchers at the University of Texas studying the same part of the brain discovered that chronic alcohol abuse changed its programming and corrupted decision-making and judgment. Still, Selby thinks addiction is both nature and nurture. “The more genetically disposed you are, the higher the chance that you will start drinking sooner,” he says. “And if the pattern in the home is drink to get drunk, rather than as part of a meal or a social lubricant, that will prime a developing brain.”

Whatever the cause, experts like Beirness say drinking tends to go in waves and right now Canadians are at a peak. But anyone looking to lay the blame on the boomers will have to look somewhere else, he says. “As people get older, they do tend to drink more frequently—but they consume less quantity. It’s a very complicated issue.” Adds O’Connor, “The most interesting statistic to me is that of the 23 million people in the U.S. right now who have a problem and don’t get treatment, 97 per cent of them don’t think they need it.”
____________
source: Maclean's

THE daily soup kitchen at St Mary's Church is an important part of Simon Leach's day. The 28-year-old, who sleeps rough in a car park in Southampton, has been coming to get free food, provided by the Society of St James, on a daily basis since he came to Southampton three months ago.

While some rough sleepers who had gathered at the church to get some warm food and catch up with their friends said that sleeping rough was a matter of choice for them, Simon was clear that this way of life was something he wanted to escape from.

"Do I want to get off the streets? Hell, yes," he said.

"I want to get into a decent job, live in decent accommodation and live a normal life. Sleeping on the streets, you just don't know what you are going to be doing from day to day - you have to put a lot of effort into trying to stay safe."

Simon first began sleeping rough at the age of 17. He stayed with friends for a while but they fell out and he found himself sleeping rough again.

Articulate and intelligent, Simon didn't fit the stereotyped image many people have of the homeless - and he wasn't the only one.

The people who were gathered for the soup run were a diverse group with a range of reasons for becoming homeless.

For some of them, like Stu, who wasn't sure of his age but thought he was around 46, sleeping rough, and the nomadic life that often accompanies it, was a way of life that he had no desire to escape from.

"This is a way of life for me," he said, "I can't get out of it."

Michael, 41, said sleeping rough was, to some extent, a matter of choice. Michael has been battling with alcohol problems and said that he has found in the past that when he has gone into hostel accommodation - the first step on the ladder away from homelessness - he has gone backwards in terms of his motivation and alcoholism.

"I've been homeless on and off since I left school," he said.

"Time goes so quickly that it becomes a way of life and then it's hard to get back into the system. If you want to get back into the system you have to start at the bottom and work your way up and that can be hard, mentally. And going into hostel accommodation you can lose your motivation and become lazy and start drinking."

Michael's friend Kelly, 37, also said she preferred sleeping rough to hostel accommodation.

She became homeless when she fell out with her family and says that she's happy with her lifestyle at the moment but is planning on getting back onto the system soon.

Another entrenched rough sleeper is 39-year-old Michelle. She has been sleeping rough most nights for the last seven to eight years and has come to depend on the soup kitchen, which she visits daily.

"If it wasn't for the soup kitchen, where would we go?" she said.

Michelle also became homeless after falling out with her family but is hoping to return to them soon.

It was with the aim of helping the whole range of homeless people that the Rotary Club of Southampton joined forces with city-based homelessness charity the Society of St James, to produce "survival packs" for the homeless.

These backpacks, which were distributed at the soup kitchen, contained items which were aimed to help take care of some of the immediate welfare needs of the homeless as well helping to get them off the streets in the long term.

They included a first aid kit, toothbrush and flask as well as items such as a diary and alarm clock to help people make sure they attend appointments such as job interviews.

All the homeless people I spoke to thought the packs were a very good idea and said it was the first aid kit that they thought they would find particularly useful.

Bob Jackson, president of Southampton Rotary Club, came up with the idea of the packs after meeting a young homeless person and talking to him about his situation.

"I came across a young lad of about 15 sitting in a car park at night with his head in his hands and he asked if I had any money," he explains.

"I asked him why he wanted it and he said that he was homeless. I quizzed him about what he wanted the money for and he said that he was on drugs. I didn't give him any money but I wanted to do something so I looked up local homeless charities and contacted the Society of St James.

"I pledged that during my year as president of the club I would link up with them and help."

Bob organised a sleep-out to help raise funds for the Society but wanted to do more. He came up with the idea of the packs as a version of the emergency packs that are sent overseas to help people cope with disasters such as flooding.

"They're not a way of resolving homelessness but they're a first step. They're a way of showing we care and of helping to make life more bearable."

He added that the response of the people who were given the packs had been brilliant and that if the feedback from the Society of St James was positive more packs would be produced.

Holly Barnes-Thomas, of the Society of St James, said the charity was delighted to be receiving help from Southampton Rotary Club.

She said the backpacks could be a lifesaver for rough sleepers and that they would hopefully help people to access the help they need to get off the streets.

Typically, there are seven people sleeping rough on the streets of Southampton on any given night, although there are far more people who are classed as homeless - staying in hostels, squats and other temporary accommodation. In March, there were more than 230 homeless or at risk of homelessness people in Southampton with more than 500 more housed by homelessness agencies.

Holly says that while it can be tempting to give money to people who are begging on the streets, generally it's best to give your money to a local homeless charity or, if you want to help the individual, buy them a sandwich and a drink rather than giving them money.

The Society of St James provides a whole range of services for the homeless, from the most basic form of support in the form of the soup kitchen through hostel accommodation to helping people deal with the problems such as alcoholism which may have led to their becoming homeless and getting them back on the housing and job ladder.

Simon Leach says he is making the most of the facilities available to get himself off the streets and back into "normal" life, but it can be tough.

"Jobs aren't that readily available for rough sleepers," he says.

"You have gaps in your employment and employers don't always want to hear that that's because you've been on the streets."

source: The Daily Echo, U.K

A new report providing analyses of substance use and mental health patterns occurring in each state reveals that there are wide variations among the states in problems like illicit drug use and underage drinking, but that no state was immune from these problems. For example, past month use of alcohol among persons aged 12 to 20 (underage use of alcohol) ranged from a low of 21.5 percent in Utah to a high of 38.3 percent in Vermont. Yet Utah had the highest level of people age 18 or older reporting serious psychological distress in the past year (14.4 percent), while Hawaii had the lowest level (8.8 percent).

The report by the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that although there are some differences in the patterns of substance use and mental health problems experienced among states and regions, all parts of the country are seriously affected by these problems.

"This report shows that although states may be uniquely affected by serious public health problems like underage drinking, every state and region must confront these issues," said SAMHSA Administrator Terry Cline, Ph.D. "By highlighting the nature and scope of the challenges affecting each state, we can help focus and target substance abuse and mental illness prevention and treatment resources."

State Estimates of Substance Use is based on the 2005-2006 National Survey on Drug Use and Health (NSDUH) and provides state-level estimates for 23 measures of substance use and mental health problems, including underage drinking, use of illicit drugs, serious psychological distress, major depression, and tobacco use. These estimates are based on combined data collected from 136,110 respondents surveyed in 2005 and 2006 (the most recent data available). The report also reveals statistically significant changes that have occurred within each state between 2004-2005 and 2005-2006.

Notable findings in this report include:

Underage Alcohol Use and Binge Drinking

Georgia had the lowest level of past month underage binge drinking of alcohol (15.2 percent), and North Dakota had the highest level (28.5 percent).

Increases in underage drinking levels between the 2004-2005 and 2005-2006 NSDUH surveys occurred in Arkansas (from 25.2 to 28.7 percent), Nevada (from 25.1 to 27.9 percent), and Vermont (from 34.0 to 38.3 percent). Arkansas and Vermont also experienced increases in underage binge alcohol use during this same period (Arkansas from 17.0 to 19.4 percent, and Vermont from 24.5 to 28.0 percent).

South Dakota's and Wisconsin's levels for underage drinking decreased from 38.3 to 34.1 percent, and from 39.5 to 35.4 percent respectively. These two states also experienced declines in the level of underage binge drinking (South Dakota dropped from 27.0 to 23.7 percent and Wisconsin went from 28.1 percent to 25.1 percent).

Illicit Drug Use

Past month use of illicit drugs for all persons aged 12 or older ranged from a low of 5.7 percent in North Dakota to a high of 11.2 percent in Rhode Island.

The percentage of persons aged 12 or older who used an illicit drug in the past month increased in the period between the 2004-2005 and 2005-2006 NSDUH surveys in Washington state from 8.5 to 10 percent. The level decreased in Kentucky during this period from 8.4 to 7.0 percent.

Utah had the lowest level of past month marijuana use among persons age 12 or older (4.3 percent). Vermont had the highest level of past month marijuana use among the same age group (9.7 percent).

In 2005-2006, Oklahoma had the highest percentage (6.7 percent) of persons aged 12 or older using pain relievers for nonmedical purposes in the past year. Hawaii, New Jersey, and South Dakota had the lowest rate in the Nation-3.9 percent.

Tobacco Use

Utah had the lowest prevalence level for past month tobacco use among persons aged 12 or older (22.1 percent). West Virginia had the highest level for this age group (40.6 percent).

Two states showed increases in past month tobacco use among persons 12 or older between the 2004-2005 and 2005-2006 NSDUH surveys -- the rate in California rose from 21.2 to 22.6 percent and the level in Oklahoma went up from 33.7 to 36.9 percent.

Substance Dependence and Abuse

The percentage of persons with a substance use disorder, including either drug or alcohol dependence or abuse, ranged from a low of 7.5 percent in New Jersey to a high of 12.3 percent in the District of Columbia.

The highest rate of illicit drug dependence or abuse was in the District of Columbia (4.3 percent), while the lowest rate was in Iowa (2.1 percent).

Kentucky had the lowest rate of alcohol dependence or abuse (6.3 percent). Montana had the highest rate (10.8 percent).

Mental Health Problems

Hawaii had the lowest level of people age 18 or over reporting at least one major depressive episode in the past year (5.0 percent) while Nevada had the highest rate (9.4 percent).

The full report is available on the Web here. Copies may be obtained free of charge by calling SAMHSA's Health Information Network at 1-877-SAMHSA-7 (1-877-726-4727). Request inventory number SMA 08-4311. For related publications and information, visit http://www.samhsa.gov/ .

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

http://www.samhsa.gov/

New research suggests that therapy based on brain activity could help alleviate chronic alcoholism and other addictions.

Would you prefer $18 right now, or $20 next month? The way the human brain makes such decisions varies significantly from person to person, according to a just-published study that provides new insights into the neurological basis of drug addiction.

The brain activity of individuals who tend to act on impulse is strikingly different from that of people who are choose to delay gratification, according to behavioral neuroscientist Charlotte Boettiger of the University of North Carolina. She goes on to report that alcoholics overwhelmingly fall on the impulsive side of the spectrum — a finding that suggests an ingrained pattern of brain activity may lead to a greater likelihood of addiction.

“Taking action without regard to long-term consequences is a diagnostic characteristic of alcoholism and other addictive disorders,” said Boettiger, who led the research project at the University of California, San Francisco. “Despite the clinical importance of this kind of impulsive behavior, little is known about how the brain either generates or suppresses impulsive decision-making. This study was designed to try to shed light on that issue.”

Using functional MRI technology, Boettiger and her colleagues scanned the brains of nine recovering alcoholics and 10 people with no history of substance abuse. The subjects were asked a series of questions that involved choosing between immediate gratification and a greater reward at a later date.

“Alcoholics were much more likely to take the immediate reward,” she reported. “There’s a range within each group, but the groups were significantly different from one another.”

As were their brain scans.

Boettiger was particularly interested in the activity of the lateral orbital frontal cortex, which she described as “the part of our brain right above our eye sockets. It’s an area that many studies have identified as being abnormal in some way or other in addicts.

“We found that people who showed very high activity in that area tended to be willing to wait for a delayed reward. People with low activity there during decision-making tended to not be willing to wait for a reward. One possibility is that this area might be necessary for creating strong mental representations of the long-term consequences of our actions.”

She found the same lowered activity in the orbital frontal context in the more impulsive non-addicts — but did not find it in the one alcoholic (out of the group of nine) who was more deliberate in his decision-making. This suggests the brain-activity patterns are probably not caused by the drug use, but rather that some people are programmed to act more impulsively, which puts them at greater risk of becoming addicts.

In light of these new insights, “It will be interesting to study various sorts of therapeutic interventions,” she said. “If we could find a drug that would elevate activity in the orbital frontal cortex during decision-making, it’s possible that could be a good candidate for supportive medical treatment for addicts. There are a lot of drugs currently available that I think would be worth testing.

“It hasn’t been very popular within the pharmaceutical industry to pursue medications for addiction,” she added. “I’m hopeful that will change. I think there’s a misconception within the pharmaceutical industry that this is not a profitable market. I think there’s a large market out there looking for help.”

Another finding that intrigued Boettiger — and may entice the drug industry — involves the level of dopamine in the brains of alcoholics. The research subjects who tended to choose immediate gratification were more likely to have a specific gene mutation that leads to lower levels of dopamine, a neurotransmitter that helps regulate emotions.

“The alcoholics in our study who have that low-dopamine (mutation) were the most impulsive choosers in our group,” she reported. “Our data suggests that having low dopamine there makes (certain areas of the brain) process calculations inefficiently.” That inefficiency, she added, may help explain why addicts have such difficulty focusing on how their present-day behavior will manifest in the future.

Boettiger calls this mixture of reduced frontal cortex activity and lower dopamine levels “a double whammy.” But the dopamine part of the equation also offers hope for a new type of treatment. “Elevating dopamine may end up being a great supportive therapy,” she said. “I would like to see that happen. I would like to test whether medications that elevate dopamine change behavior. Our data strongly predicts that it would.”

Boettiger plans to follow up this research with pharmacological studies, as well as by looking at brain-activity patterns of people who have a family history of alcoholism, but have yet to show any symptoms. That study could show whether impulse-oriented brain-activity patterns are hereditary. “I would hope to do that in the next year,” she said.

If that research proves her hypothesis, Boettiger can envision a day when we routinely scan the brains of children born into families where addictions are common. “I think it’s important for kids to be warned early that they are at risk,” she said. “This may be another tool.”

In addition to such early warnings and potential drug treatments, Boettiger believes these findings could help refine talk therapy for addictions. “A lot of behavioral therapies used to treat addicts today focus on helping people strengthen their mental representations of the long-term consequences of drinking or drug abuse,” she noted. “It would be interesting to see whether that therapy changes brain-activity patterns.

“I know (Alcoholics Anonymous) has helped many people, but it was designed in the 1930s,” she added. “I think we have learned some things that we didn’t know then.”

source: Miller-McCune

Addiction medication and sage advice could be dispensed from a physician's office.

British songstress Amy Winehouse, who croons "no, no, no" to rehab, has a lot of American company this time of year -- both in her heavy-drinking ways and her unwillingness to spend weeks in a specialized facility to get sober.

But experts say there may be new hope for rehab refuseniks like Winehouse and an estimated 5.7 million alcoholics in the United States who are not in treatment -- hope that could be as close as the family doctor.

New research and a growing arsenal of medications have set the stage for a major shift in the treatment of alcoholism, from specialized clinic to the "primary care office setting," the Journal of the American Medical Assn. reported in its Dec. 5 issue.

But if the promise of "office-based" treatment of alcoholism is to become a reality, the nation's 337,000 general-practice physicians -- and the systems within which they work -- will have to undergo some transformation themselves, addiction experts say.

Doctors must overcome their reluctance to broach the subject of drinking and learn how best to intervene when they suspect alcoholism. Medical practices may need to add staff to help counsel recovering patients. And insurance companies and federal insurance programs will need to be persuaded to reimburse patients for medication that can be costly and to pay physicians for taking on a new role in patients' care.

Several new drugs are making office-based treatment a realistic prospect. In April 2006, a monthly injectable form of the drug naltrexone won approval from the Food and Drug Administration. Marketed as Vivitrol, the new formulation of a long-available drug can be started after only four days of abstinence and appears to cause less nausea than pills taken daily -- features that make it easier for patients to start and stay on the treatment. It joined two other medications approved to curb alcohol cravings.

Evidence is growing for the effectiveness of these and other addiction medications, such as the anti-convulsive drug topiramate, which, although not FDA-approved for this purpose, is also widely prescribed off-label to help alcoholics stay away from drink. And more FDA approvals for drugs that treat alcohol dependence are on the horizon.

At the same time, studies published this year underscored the effect that a few frank words from the doctor can have on patients whose drinking appears to have become excessive.

These developments could be the "tipping point" into a new era of alcohol treatment, says Mark Willenbring, director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism. With new confidence in their powers of persuasion and new pharmaceutical tools in their black bags, primary care physicians -- who have been notoriously shy of confronting patients about their drinking habits -- may grow more willing to flag an alcohol problem, offer medication and dispense advice during routine office visits, Willenbring says.

In turn, as patients grow more confident that they can curb their drinking without the time, expense and stigma of a stay in a clinic, more will likely step forward for help.

Parallel with depression

"In many ways, we are with alcoholism where we were with depression 30 years ago," Willenbring says. As a new generation of antidepressants came to market in the early 1980s, physicians on the front lines of patient care grew more attentive to the signs of depression and more willing to treat it. Patients with protracted bouts of blue mood turned to their family doctors for help in increasing numbers.

In the process, depression was transformed from a highly stigmatized mental illness that was rarely treated before a suicide attempt or outside a psychiatric hospital to a condition for which 80% of patients turn first to a general medical practitioner.

A similar shift in the treatment of alcohol-related disorders won't happen overnight, Willenbring says. But with 19.5 million Americans thought to have alcohol-related disorders in 2006, and only 1.6 million getting specialized treatment, he says, "we have to start thinking creatively about how to provide more accessible, appealing and creative options" to encourage patients with drinking problems to get the help they need before they hit the skids.

Experts warn, however, that as general-care physicians armed with medications shoulder a greater role in treating alcohol dependence, patients and public officials must ensure that the sickest patients do not suffer in a rush to treat alcoholism more economically.

In that regard, not all experts see depression treatment as an encouraging example. Medication has worked wonders for many depressed patients. But a study published in 2001 found that only about one-quarter of depressed patients seeing a general practitioner got appropriate care. Meanwhile, insurance companies keen to reduce spending for depression care have limited patients' access to costly psychotherapy, despite studies showing that patients improve most when such therapy is paired with medication.

As anti-alcoholism drugs show gains in effectiveness, many fear that insurance companies and federally supported programs will rely largely on medications and the brisk medical management of primary-care doctors.

That, they fear, could deny alcoholics who need the extra support of intensive rehabilitation the care they need to quit.

"You'd have to be naive not to be a little concerned that that will happen," says Mitchell Karno, UCLA's alcohol treatment researcher.

Doctors, too, will have to make changes if this new era of "office-based" alcohol treatment is to become a reality, experts say -- and some aren't convinced that the changes will easily happen.

"It's a vision that has some benefits to it, but it's not a done deal at this point," says Richard Rawson, associate director of UCLA Medical School's Integrated Substance Abuse Programs.

Rawson observed one crucial obstacle when he tried to launch a pilot program in which U.S. primary care doctors would screen patients for risky or excessive alcohol use and provide "brief interventions" intended to get those with problems to quit or reduce their alcohol consumption.

In all, the prescribed screening and intervention initiative would have taken physicians 10 minutes, Rawson says. He approached five institutions in an effort to recruit support.

None bit.

"What we hear over and over again is, 'Look, we have seven minutes to do whatever it is we're going to do. To take five minutes to do screening and then another five to do a brief intervention on this one dimension of health problems is just not in the cards,' " Rawson says. "I don't think we're at a point where we can just dump it all in the laps of primary care docs."

Rawson adds that in addition to physician training, other things would also have to change to account for the new demands -- such as systems of payment, insurance reimbursement and the office structure of general care practitioners.

Another obstacle experts see: Doctors are generally wary of challenging patients in matters that involve emotionally charged personal habits such alcohol consumption as well as smoking and obesity. And patients, in any case, almost always lie about their habits.

Physicians frequently hesitate to raise the question unless a patient is showing clear evidence of alcohol-related damage -- including impaired liver function, high triglycerides or bloated red blood cells. "It's like, 'Don't ask, don't tell,' " says New York internist Dr. Steven Lamm, who has successfully treated a number of patients with medication, including the monthly injectable version of naltrexone. That's especially been the case, he adds, because of the perceived paucity of medical treatments they have to offer. "What are you going to do about it? Send them to Alcoholics Anonymous?" he says.

Change is in the air

In the new climate, such reluctance might change.

As pharmaceutical companies launch new drugs -- and new marketing campaigns for them -- doctors will grow more assertive about raising the issue, says UCLA geriatrician Dr. Alison Moore, who sits on a panel at Willenbring's NIAAA that reviews the effectiveness of alcoholism treatments.

But, Moore adds, in addition to writing prescriptions for new drugs, physicians also had better learn new scripts for how to talk to patients about their alcohol problems and where to refer them if they need more help than a pill or an injection can provide.

"They're better than nothing," Moore says of the available medications. "But I don't see them as wonder drugs." They don't work for all patients, and even when they do, patients frequently relapse, she adds.

A new era in alcohol treatment may also bring new definitions of sobriety, as well, experts say. Programs such as Alcoholics Anonymous, as well as most of those who treat alcoholism, have always drawn a clear line between sober -- completely abstaining from alcohol -- and alcoholic.

As alcohol treatment grows more accessible, however, a wider range of patients -- including those who are not alcohol-dependent, but who endanger their health by drinking to excess -- are expected to come forward for treatment. For these patients, support groups like Alcoholics Anonymous may be less relevant than newer groups such as SMART Recovery and Rational Recovery, less ubiquitous than AA, which emphasize a goal of moderation in drinking.

In January, the NIAAA will launch a print- and Web-based self-help program called "Rethinking Drinking," aimed at a wide range of drinkers, including those with what Willenbring calls "a mild form of alcohol dependence."

The emergence of these alternatives to AA is certain to reignite a long-running debate over what goals alcoholism treatment should embrace. And it will likely spark efforts to define more broadly the range of patients who have a drinking problem, as well as those who could benefit from preventive or early treatment.

UCLA's Mitchell Karno says that patients and their family doctors will likely work out their own solutions. "People will seek out the level of treatment that's going to match their need," Karno says -- whether it's eight weeks in rehab, or a pill, an encouraging word from the doc and a self-help book.

Between strict abstinence and a safer level of drinking, Karno says, "it will be up to physicians and patients to choose how they're going to negotiate that tension."

source: Los Angeles Times
melissa.healy@latimes.com

● Contact reporter Stephanie Innes at 573-4134 or sinnes@azstarnet.com.

In a rare political statement, B.C.'s highest court says system is clogged with out-of-control repeat offenders -- with no resources to aid them...

The B.C. Court of Appeal issued a plea to Victoria on Friday to improve treatment resources for mentally ill and addicted recidivists who are clotting up the criminal legal system.

At the end of a unanimous decision, three justices -- including Chief Justice Lance Finch -- concluded a lower court judge had difficulty sentencing a 27-year-old repeat offender because there was no medical help available.

They said the case was emblematic.

"This court can do no more than to acknowledge the lack of resources and urge our legislators to respond to the need," Justice Catherine Anne Ryan wrote for the panel.

It was a rare politically tinged comment from the province's highest bench and it touched a hot-button issue.

Mentally ill and addicted repeat offenders clog the system and what to do about them is a Gordian knot.

More jail time -- the solution some propose, doesn't help this population, in my view, because they're not bent, they're broken. These people aren't making criminal choices, they're out of control.

This judgment leans in the same direction.

Justice Ryan said this case "demonstrated the difficulty of sentencing the mentally ill offender, especially those who are also addicted to alcohol and/or drugs."

She said the courts are being asked to deal with offenders who cannot be controlled via ordinary probation orders because treatment services are not available.

As a result, they are released only to reoffend because they haven't received any help with their underlying problems.

Consider this case.

Over the course of six weeks, would-be Victoria artist Jonah Jae Donato committed six crimes culminating in a robbery.

On March 9, he pleaded guilty and was sentenced to a total of just over seven months' imprisonment to be followed by two years' probation.

At the time, the judge duly warned Donato that when he was released on probation he was to be of good behaviour, refrain from drugs and alcohol and to get treatment.

"Without treatment to back up the admonitions, such orders will often do the opposite to what is intended -- create a simple path to reoffending," Justice Ryan noted.

"Apparently, no treatment facilities were available to Mr. Donato at the time he was sentenced."

Which meant he remained on the legal system's treadmill.

Donato's first crime in this spree was spray-painting an outside wall of the Odeon Theatre in Victoria on Dec. 5, 2006.

He was drunk and told the officers he was trying to convey his message that the streets were dangerous. He was arrested for mischief and released.

On Dec. 10, Donato spray-painted an office building. He was drunk.

A private security guard stopped him on Jan. 11, stealing a bottle of beer from a downtown liquor store.

Donato was arrested and released on a promise to appear and not consume alcohol while awaiting trial.

On Jan. 12, he was found unconscious in the washroom of a local Blenz Coffee shop, a bottle of Drambuie by his side.

Five days later, he was caught bingeing on the street.

Lastly in this string of offences, on Jan. 18 wearing something resembling a veil, Donato drunkenly demanded money from an adult video store clerk.

The clerk handed him $20 and pushed a silent alarm.

Donato was in another part of the store stuffing merchandise into his jacket pocket when police arrived.

None of this behaviour should have been surprising.

Donato has a related record of eight thefts, fraud, assault, and mischief.

All of those crimes were similarly alcohol-fueled escapades and were dealt with in 2006 -- the longest sentence he received amounted to 30 days' incarceration followed by probation for a year. He was on probation when these offences were committed.

A psychiatric report filed with the court says Donato is afflicted with schizoaffective disorder and polysubstance abuse.

He has been admitted and received psychiatric treatment numerous times. Yet he is resistant to counselling and medication.

Released from jail on Sept. 17, Donato quickly breached his probation, pleaded guilty and on Oct. 1 was sentenced to 30 days.

He was released Oct. 20, but 10 days later was charged with three further breaches of probation along with theft under $5,000 and possession of stolen property.

He was released Nov. 1, having promised to admit himself to the Seven Oaks Mental Health Facility where a bed is now available.

"Mr. Donato's rehabilitation will not take place unless he receives treatment to address his mental health and addiction issues that give rise to his anti-social behaviour," Justice Ryan said.

"Fortuitously, the Seven Oaks Mental Health Facility has a bed for Mr. Donato and he agreed, pursuant to a bail order imposed Nov. 1, to take treatment at the facility... The conditions imposed by the sentencing judge, now tied to treatment, may provide the rehabilitative effect for which they were intended."

Donato was before the appeal court asking to have those conditions relaxed. And the court obviously had great sympathy.

He said he couldn't live without a drink and Justice Ryan said that was probably realistic.

His chances of rehabilitation had improved, she said, so the court would amend the proviso that he "refrain absolutely from ingesting alcohol or non-prescription drugs to a condition that requires that he not be found intoxicated in public."

Donato wanted access to an area of downtown Victoria from which he is currently prohibited -- "the south side of Fort Street to the south, the east side of Quadra Street to the east, the north side of Herald Street to the north, and the west side of Wharf Street to the west."

The appeal panel said that provision would remain in place because the area is where his crimes took place and offers easy access to illegal drugs and alcohol.

"If he needs to go to the area he can do so with the permission of his probation officer," Justice Ryan concluded.

Donato also wanted the ban on possessing "any spray paints, marking pens or any other items that could be used to create 'graffiti'" eased.

The panel varied that condition to say "he not carry spray paint in public."