Sober N Clean

You might not just realize this while downing a mug of chilled beer on a summer afternoon, but a new study has revealed that too much alcohol can cause permanent damage to brain.

The study has shown that too much alcohol can also cause brain injury and degeneration by inhibiting insulin and insulin-like growth factor (IGF)

With the help of postmortem human brain tissue, researchers showed that chronic alcohol abuse can decrease levels of genes needed for brain cells to respond to insulin/IGF, leading to neurodegeneration similar to that caused by Type 2 diabetes mellitus.

"Insulin is one of the most important hormones in the body," said Suzanne de la Monte, professor of pathology/ neuropathology and clinical neuroscience at Rhode Island Hospital and the Warren Alpert School of Medicine at Brown University.

"It has many functions, including regulation of metabolism. Cells throughout the body depend upon insulin just to stay alive and carry out 'ordinary daily functions. The best known diseases associated with abnormalities in insulin's availability or actions are Type 1 and Type 2 diabetes," she added.

The study showed that in chronic alcoholics' brains, there was significant insulin and IGF resistance in those regions known to be highly sensitive to alcohol's toxic effects.

"Alcohol is a toxin that clearly can injure or kill brain cells," de la Monte said.

"Fortunately, alcohol has to pass through the gastrointestinal tract and liver where enzymes detoxify alcohol, and consequently reduce the levels that reach the brain.

“However, in either high concentrations, or at lower levels over a longer period of time, alcohol will dissolve some of the lipid in the cell's membrane," she added.

During the study, researchers examined brain tissue from six male chronic alcoholics with a mean age of 57.7 years, and six male "controls" without alcoholism with a mean age of 57.5 years.

Two brain regions were selected for study – the cerebellar cortex, which sends information to the muscles causing them to move and cingulate gyrus in the frontal lobe, involved with emotion formation and processing, learning, and memory. These were major targets of alcohol's neurotoxicity.

The results showed that in chronic alcoholics' brains, there was significant insulin and IGF resistance in those regions known to be highly sensitive to alcohol's toxic effects.

De la Monte added that the insulin resistance their study found was quite similar to what happens in Type 2 diabetes, which means that alcoholic brain disease may be treatable in part by use of drugs that make brain cells more responsive to insulin and IGF.
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source: Times of India

For the last few years, I've thought a lot about how to change the treatment system so that helps more people overcome addiction and gain a better life. At one stage, I had come to the conclusion that I needed to work with the people at the top, to help them understand the shortcomings of the current treatment system and see how it could be changed.

I gave a talk at the FDAP Annual meeting last year where I described the shortcomings of the system and emphasised that unless we did something we would end up like the American treatment system in the late 1980s and early 1990s - money was slashed and the system collapsed. I also pointed out the way we needed to move forward, which I
have reiterated in the Wired In 'Way Forward'.

I had a very positive response to my talk from a senior person within the NTA and I thought that I could enter into some long-term dialogue with the NTA that would lead to positive change. A change to a treatment system that is based on people attaining recovery - and I mean a genuine recovery, not some politicised excuse of recovery - is inevitable sooner or later. I thought that I could help speed up the process.

Well, after seeing the Paul Hayes article in the Guardian today, I realise how naive I have been. I'm not going to go into any great detail about the article, but I have to confess that it has made me angry. I quote, 'Hayes dismisses his critics as a few academics, politicians and "ideologues" stocked up by the media'. This is absolute rubbish - Paul Hayes either has his head very deeply buried in the sand or he is deliberately being untruthful.
There are many, many thousands of people out there who know that the current treatment system is NOT working and is causing damage to many people. These people who know the truth come from many different aspects of life - they are users, ex-users, family members, practitioners, commissioners, members of the general public, etc.

I've been in the North West for the past couple of days and it was quite clear to me that the people I spoke to all knew many people who know the system is not working and are tired of the NTA spin. Even some commissioners who do not really care about people with substance use problems realise that the way methadone is being used in many treatment programmes is not reducing crime and is storing up problems for the future.

Anyone can use words to create a false story, mislead people by playing with facts, and distract them by creating false concerns. Sooner or later such people are found out for what they are doing. It is time that Paul Hayes is found out for what he is doing. I encourage those people who do not believe that the current treatment system is working to write to Gordon Brown and tell him. Write and complain that Paul Hayes is misleading the country about what is truly happening.

We are talking about people's lives here. They are far more important than defending the current treatment system. Mr Hayes may think that few people will stand up and be counted - and maybe initially this will be the case. But there is a gathering momentum in the country for a treatment system that is focused on improving people's lives - rather than giving them a pill to keep them quiet - with an increasing number of people getting fed up with Mr Hayes's spin. The day of reckoning will come.
People with substance use problems need opportunity, choice and hope. The UK treatment system is not providing these key elements.

I leave you with a quote from Stuart Honor,
'It is no great trick to take an impoverished, unemployed individual who is addicted to heroin (and crack?) and turn him (sic) into an impoverished, unemployed individual who is addicted to heroin, crack, methadone and/or alcohol and benzodiazepines.'
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source: http://davidclarkwired.blogspot.com/

The head of the National Treatment Agency dismisses 'ideologues' who claim his organisation's addiction programmes aren't working. 'The evidence in favour is overwhelming'.

After seven years at the helm of the National Treatment Agency for Substance Misuse (NTA), Paul Hayes is adamant that the addiction programmes he has overseen during his tenure are working. Not everyone is so convinced. On Radio 4 last week, Hayes was forced to defend his record against criticism that the current strategy of "treatment management" - using, for example, methadone for heroin addicts rather than "curing" their addiction - was failing and wrong-headed.

Hayes dismisses his critics as a few academics, politicians and "ideologues" stoked up by the media. He says any notion that investment in treatment programmes - central government funding has risen from £60m in 2001 to £400m in 2008-09 - has been a failure is wrong. The idea that treatment based on harm reduction could be replaced in future by an "abstentionist" approach, where success is measured primarily by the number of addicts "cured", is misguided, he insists. "We need to keep maintenance prescribing as an integral part of the drug treatment system because it stabilises people, reduces crime, reduces deaths."

The number of problem users in contact with treatment services has more than doubled in the last 10 years, from 85,000 to 195,000. Hayes says this is a clear indication that the system is working, but is far from the whole picture. Treatment centres, he insists, are also about taking the opportunity to ensure they help "as many people as they can to overcome their addiction, leave treatment and get on with their lives. But that's always been the objective of policy, so to a large extent a false division has been created. Rather more has been made of this very sharp split than it actually warrants."

There is an element of electioneering and political expediency to the current debate, Hayes suggests. "There was a political consensus for some time that drug treatment was a good thing and that, therefore, the more we had of it the better. There was consensus that the maintenance-led prescribing regime, which has got all the evidence behind it, is right. The National Institute for Clinical Excellence says it's the right approach, the World Health Organisation says it's the right approach - but always with an expectation that those people who could leave treatment free of their drug dependency should be encouraged to do so."

So if this is the case, why is there a debate now? Is it that the evidence doesn't stack up? Hayes says the evidence is clear and robust. "There are 130% more people in treatment than when we started [in 2001], rather than half the people dropping out because treatment isn't of good quality."

Chaotic lifestyles

But it isn't just about treatment numbers, he says. The impact on crime and a reduction in the social fallout from the chaotic lifestyles of problem drug users is also important to understand, he insists. "Long-term crime is falling, and when we match the criminal histories of people going through the treatment system, we show a reduction in arrests and charges. A York University study showed that for every £1 invested in treatment, the community gets £9.50-worth of benefit back - most of which is crimes that haven't happened."

Hayes suggests criticisms began to gain traction a year-and-a-half ago when the Conservative party's Social Justice Policy Group, headed by Iain Duncan Smith, published its Breakdown Britain report. A lengthy document examining the causes of social breakdown and poverty, the report concluded that an "explosion of addiction" was a major factor in fostering wider social exclusion. The possibility that policy might change direction under a future Conservative government was also mooted when it asked if current policy was "treating the symptoms rather than the causes", and concluded that treatment was being pushed in "the wrong direction, preferring maintenance to recovery".

Hayes insists that, despite the signs of a sea change indicated by Breakdown Britain, "the political reality" is very different. "If you actually scrape away the rhetoric of Breakdown Britain, you find people saying, 'Yes, methadone does work. We're not actually anti-methadone, but it's been given too much of a role in the past.'" He cautions against reading too much into the report. "What you promise in opposition and what you are forced to deliver in government are very different. You have to face the reality of the evidence and the resources you have available."

But how can Hayes be so sure that drastic changes in policy direction are not on the horizon if a Conservative administration does make it to Downing Street? If past performance in government is anything to go by, he says, then pragmatism dictates what is done. He points out that the "shift in policy away from an abstinence-driven policy towards a harm reduction policy took place when Margaret Thatcher was prime minister".

It also comes down, he says, to the fact that "very few people will deny there's a correlation" between drug dependency and crime. He argues that this, along with the "many complex problems" such as mental health difficulties that tend to come with people who are drug-dependent, tends to steer politicians down a more pragmatic path when in power.

So does Hayes concede anything to his critics? He admits that if the funding dries up things could get difficult - but says there is enough "for the moment". He also accepts that as the cash has been "pumped in" and local treatment services have expanded, quality of provision and cost-effectiveness has not always kept up. "You can't do that overnight," he says, adding that improving the quality of services - and therefore outcomes - will be a focus for the NTA for the next three years. Addressing critics who might say progress isn't coming quickly enough, he responds: "There is inevitably a time lag between the investment and the investment bearing fruit."

As for the future, Hayes sounds confident. "The evidence in favour of current approaches to treatment are overwhelming," he says. "The evidence and the cost-effectiveness will stand the test of examination and will stand up to whatever political spin is put on it. It may well be recast, relabelled, repackaged, but the evidence is the strength."
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source: The Guardian U.K

The Center for Behavioral Health offers treatment to help people regain control of their lives

At first, Erika Sternberg and Dan Templeman used prescription painkillers to relax and have fun on the weekends.

Then Erika's father, whom the Boise couple loved dearly, died about two years ago. That tragedy changed the role of drugs in the couple's life. Vicodin, a prescription opiate, wasn't for having fun. It was for getting numb.

"I couldn't have a peace about (the death)," Sternberg said. "It really disturbs my soul."

During two years of drug use and attempts to quit, the couple hit bottom several times.

The Center for Behavioral Health in Meridian opened when the couple needed it most.

With daily treatment, Sternberg, 27, and Templeman, 30, have started to put their lives back together.

Until this spring, Idaho was one of only a few states without a methadone clinic. Methadone is a synthetic form of morphine that helps most people wean themselves from opiates or heroin.

The Center for Behavioral Health, which opened April 7, is part of a for-profit chain of centers in nine states. The outpatient facilities offer treatment and counseling for every addiction.

Fewer than 30 people are in treatment at the Meridian center, partly because of the downturn in the economy, said co-owner Brant Massman, of Boise.

"The response has been very positive," Massman said. "However, because of the economy being where it's at, I can't say that things are booming."

For Templeman, the road to addiction started with surgery to remove his gall bladder. "That's pretty much how most people get hooked on stuff like Vicodin," he said.

At first, Templeman simply asked his doctor for more refills "and then pretty much you just buy them from people," some of whom had unused prescriptions, including for OxyContin, which carries a national reputation as a highly addictive opiate sometimes prescribed to relieve severe pain.

Sternberg was making good money at an office job and bought presents for Templeman, who worked at the Boise Airport.

In addition, she said, "We had gotten my wedding ring."

Eventually, Templeman's sources of prescription painkillers dried up. He decided to use heroin. He said it was to wean himself off prescription painkillers.

"First, we did it just on the weekends, and it just gradually increased," Sternberg said. "We'd do it two days in a row and then ... after a while you just have to have it."

Desperate to hang on to their jobs, the two tried to find a detox center in Boise to get help. With no health insurance, they came up empty. They were missing a lot of work and performing poorly because of their drug habits, and they were afraid of losing their jobs. They pawned possessions to get money.

"It was both depressing and humiliating," Sternberg said. "There were several times I would just break down and cry, but I just couldn't stop."

Through relatives and friends, they heard about a detox program in Seattle, but were unable to stay long enough for aftercare and were using again within a few months.

They went to a methadone clinic in Ontario, but fell behind on paying for their medication and were forced to leave the clinic for nonpayment.

Withdrawal followed.

"You want to keep thinking of ways to die, but you are too weak to do it," Sternberg said. "If there had been a gun, you would have pulled the trigger, because you just want it to end. You don't want to die, but you want a way out."

Since starting their treatment at the Meridian clinic things are looking up.

"For the first time, I don't crave any alcohol or drugs or anything," Sternberg said.

At the Meridian clinic, the couple pays $55 each a week for a daily dose of methadone in a cherry-flavored liquid.

The pair recently began working at Deseret Industries, where they make less than $6 an hour hanging clothes and sorting merchandise for a second-hand store. Deseret Industries, sponsored by the Church of Jesus Christ of Latter-day Saints, will also provide up to $3,000 to help the non-Mormon couple learn a trade or career skills, they said.

The couple's only wish: That the state's Medicaid program would help addicts pay for maintenance, as a few other states do.

"(Addiction) can affect anybody," Sternberg said. "It doesn't mean that you're a bum or homeless or a junkie or any of those things."
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source: http://www.idahostatesman.com

A study from Massachusetts General Hospital (MGH) supports previous reports that adolescents with bipolar disorder are at increased risk for smoking and substance abuse. Researchers say the study is a reminder that teens with bipolar disorder should be screened for drug and alcohol use and abuse.

“This work confirms that bipolar disorder (BPD) in adolescents is a huge risk factor for smoking and substance abuse, as big a risk factor as is juvenile delinquency,” says Timothy Wilens, MD, director of Substance Abuse Services in MGH Pediatric Psychopharmacology, who led the study. “It indicates both that young people with BPD need to carefully be screened for smoking and for substance use and abuse and that adolescents known to abuse drugs and alcohol – especially those who binge use – should also be assessed for BPD.”

It has been estimated that up to 20 percent of children and adolescents treated for psychiatric problems have bipolar disorder, and there is evidence that pediatric and adolescent BPD may have features, such as particularly frequent and dramatic mood swings, not found in the adult form of the disorder. While elevated levels of smoking and substance abuse previously have been reported in young and adult BPD patients, it has not been clear how the use and abuse of substances relates to the presence of BPD or whether any increased risk could be attributed to co-existing conditions such as attention-deficit hyperactivity disorder (ADHD), conduct disorder or anxiety disorders.

The current study, which appeared in the June issue of Drug and Alcohol Dependence, analyzes extensive data – including family histories, information from primary care physicians, and a detailed psychiatric interview – gathered at the outset of a continuing investigation following a group of young BPD patients into adulthood. In addition to 105 participants with diagnosed BPD, who enrolled at an average age of 14, the study includes 98 control participants of the same age, carefully screened to rule out mood disorders.

Incidence of each measure – alcohol abuse or dependence, drug abuse or dependence, and smoking – was significantly higher in participants with BPD than in the control group. Overall, rates of substance use/abuse were 34 percent in the bipolar group and 4 percent in controls.

The data also indicated that bipolar youth whose symptoms began in adolescence were more likely to abuse drugs and alcohol than were those whose symptoms began in childhood. “It could be that the onset of mood dysregulation in adolescence puts kids at even higher risk for poor judgement and self-medication of their symptoms,” Wilens says.
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source: Coalitions Online

A Regina man believes most people are binge drinkers if you accept the medical definition of a "binge."

"Binge drinking is defined by a number of different sources as consuming five or more drinks for males and four or more for females on one occasion," said Marta England, supervisor of the Alcohol and Drug Education and Prevention Directorate with the Ministry of Health.

The sources include the Canadian Medical Association, a Canadian Addiction Survey and the Centre for Addiction and Mental Health.

The definition astounds Kyle Wylie.

"If I'm going out with some friends for dinner and then maybe we go to a sit-down pub, we'll probably have five drinks in the span of five hours, so is that a binge drinker? By this definition yes, but I wouldn't consider it that way," said the 23-year-old.

Wylie believes a binge drinker is someone who drinks so much that he or she can't make responsible decisions.

"There are females who can drink five or six drinks and be reasonable and there are guys who can drink two or three drinks and be totally unreasonable," he said. "I was a binge drinker most of high school and a lot of my friends and a lot of the people who were in my high school would definitely say they were binge drinkers too -- by my definition, drinking until you're out of control."

Polling was done in 2006 to determine the consumption levels of young Saskatchewan adults so that educational campaigns about the dangers of binge drinking could be tailored for them.

"The campaigns that we've done have focused on the 18- to 29-year-olds who tend to have the heaviest consumption," England said. "Nearly 30 per cent said they had consumed more than five drinks on at least one occasion and 40.5 per cent said they'd consumed more than 10 drinks on at least one occasion in the past 12 months."

Wylie doesn't dispute the statistics.

"In high school, you'd show up with a 12-pack, not a six-pack -- those statistics are very bang on," he said.

England said binge drinking isn't just a problem in Saskatchewan but across the country and world. Since alcohol is a legal drug that's socially acceptable, drinking seems to go hand in hand with celebrations, but that comes at a cost, she said.

According to the Ministry of Health, alcohol use costs Saskatchewan $508.7 million in lost productivity, absenteeism and disability.

"These are some things that we've got to think about -- is it OK for it to be a rite of passage or is it too costly to be a rite of passage?" England questioned.

While the public has received education about the harms associated with drinking and driving, she said many are unaware of the dangers associated with binge drinking.

"There's all sorts of assaults and fights that happen, unplanned, unprotected or unwanted sexual relations, sexually transmitted infections as well as the more long-term physical harms such as memory loss," she said. "Those are some of the harms that we talk to young people about."

Drinking large amounts of alcohol in a short period of time is more harmful to brain cells than any other pattern of drinking.

"Young people still have that infallible sense that 'it won't happen to me,' so we have to go beyond that and have some community and provincial policies in place that reinforce them to make better decisions," England said. "One thing that we did last year and that we're planning for this year again is to get information into Welcome Week packages and orientation packages at the post-secondary institutions."

She said students want to know about the hazards but don't want to be told what to do.

"We talk about alternative kinds of activities that people can be involved in with both younger youth and the post-secondary youth but some of them have indicated that non-alcoholic sponsorship of events is very hard to come by," England said. "It takes a lot of partners and a lot of different approaches to take a look at binge drinking."

Wylie agrees youths will be turned off by a preachy approach and suggests that young adults whose drinking has caused problems should share their experiences with students.

He drastically cut back on his drinking after he suffered blackouts.

"There's a point where you say, 'Wow, why did I do that?' or you wake up in the morning and you say, 'What did I do?' That made me realize that I had to make a change," he said.

Binge Drinking in Saskatchewan

Of 499 young Saskatchewan adults between the ages of
18 and 29 years who were surveyed in 2006 . . .

42% said they drank more than they intended at least once in the past 12 months.

27% said that, on at least one occasion, they couldn't remember events of the previous night due to drinking.

30% reported they had consumed more than five drinks on at least
one occasion.

15% said their drinking had resulted in someone being physically
injured during the past year.
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pcowan@leaderpost.canwest.com

© The Leader-Post (Regina) 2008

World donors promised Afghanistan more than $20 billion (£10 billion) of new aid, plus fresh moral support, yesterday, but told President Karzai that they were losing patience with his Government’s failure to stem rampant graft and drug trafficking.

Under international pressure over the lack of progress in rebuilding his country, Mr Karzai promised to fight corruption and sought understanding. Poppy-growing farmers, for example, needed help, he said. “Opium is about survival for them.”

The United States, represented by Laura Bush, its First Lady, opened the pledges at the Paris donors’ conference with a $10.2 billion commitment over five years. “Afghanistan has reached a decisive moment for its future. We must not turn our back on this opportunity,” she said.

David Miliband, the British Foreign Secretary, promised £600 million. He praised progress made in security and healthcare but said that there was a long way to go in building good governance in Afghanistan. The growing links between the insurgency and the drugs industry - which, Mr Miliband said, was reflected in the haul of 235 tonnes of cannabis resin worth about £200 million - had to be tackled.

The total was well short of the $50 billion that Mr Karzai was seeking from the 80 nations and organisations that have already promised $25 billion since 2002. Only $15 billion of that has been spent so far, much of it ineffectively and wastefully, according to aid experts. Afghanistan depends on aid for 90 per cent of its needs.

Nevertheless, Bernard Kouchner, the French Foreign Minister, called the conference “an unexpected success”. “We had hoped in our most optimistic moments to raise perhaps 17 billion at the most,” he said.

President Sarkozy of France led a chorus of support for Mr Karzai’s fragile Government as the best hope for Afghanistan. “It is the duty of all democrats to help you,” he said. Mr Sarkozy, who has deepened French engagement with the forthcoming deployment of 900 combat troops, said that Afghanistan “was taken hostage by a regime allied to terrorism”.

About 8,000 people were killed last year in the fight with a rejuvenated Taleban, which is trying to break Western will to keep the Nato-led force of 47,000 in Afghanistan.

Ban Ki Moon, the UN Secretary-General, called for “active measures” against corruption, more transparency and better management of aid.

Stephen Smith, the Australian Foreign Minister, said that reconstruction had been slow. Mr Smith told The Times that “the Afghan Government has to start taking some responsibility” for the administration of the aid funds.

Mr Karzai cited progress in building roads and hospitals, and in fighting opium production since the 2001 fall of the Taleban regime, but he acknowledged: “There is a long way still ahead of us . . . Afghanistan needs adequate, long-term and predictable support.”
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source: http://www.timesonline.co.uk