October 10, 2008

Research Summary

A brain imaging study conducted by researchers at Massachusetts General Hospital revealed that abnormalities appearing in the cerebral cortex of cocaine addicts correlate with dysfunction in regions of the brain responsible for attention and reward-based decision-making. 

While some of these abnormalities may reflect a predisposition to drug use, others may result from long-term cocaine exposure. "These data point to a mixture of both drug effects and predisposition underlying the structural alterations we observed," said Hans Breiter principal investigator of the Phenotype Genotype Project in Addiction and Mood Disorder.

Magnetic resonance imaging studies of 20 cocaine addicts and 20 control participants were used to determine variations in cortical thickness. Compared to the healthy controls, the cocaine addicts had significantly less overall cortical volume. The difference was markedly apparent in areas that control reward functioning and decision-making. In addition, typical differences in thickness in the frontal regions of the cortex was reversed for the addicts compared to non-addicts.

"The severity of these cortical alterations point to the potential importance of prevention efforts to keep susceptible individuals from beginning to use cocaine," Breiter said. He suggested that further large-scale testing of individuals with different addictions is needed "to see if these findings are limited to cocaine users."

The report appears in the Oct. 9, 2008 issue of the journal Neuron.

October 9, 2008

News Summary

Addiction treatment and recovery advocate William Cope Moyers has written a new book titled "A New Day, a New Life: A Guided Journal" that explores the rewards and challenges of the first year of addiction recovery, the Fort Wayne (Ind.) News-Sentinel reported Oct. 6.

"Treatment is where the journey starts," Moyers said, but the road to successful recovery "requires daily commitment and effort."

In the book Moyers discusses different approaches to addiction treatment and recovery. Writing about addiction science, Moyers noted that for 10 percent of the population drugs or alcohol "turns a switch on in your head that you can't turn off." The book also talks about the 12-step approach to recovery and the work done by Alcoholics Anonymous.

This is the second book for the author, the son of television journalist Bill Moyers. It follows his 2004 memoir, "Broken: My Story of Addiction and Redemption." Moyers is currently an executive at Hazelden's Center for Public Advocacy.

"A New Day, a New Life: A Guided Journal" is published by Hazelden Publishing.

Residential Treatment

Residential treatment centers are in a secluded setting and provide nonstop daily care. They are commonly therapeutic communities which have a planned length of stay between 30 to 90 days. Their primary focus is on the rehabilitation of the individual and most of them use the facility's entire community, such as the residents and the facilities staff. Residential treatment develops personal accountability, responsibility and socially productive lives. Recent research has indicated that the most beneficial length of stay for people in drug rehab is 90 days. Our professionals can help you locate the most appropriate drug rehab for you loved one.

Short term residential treatment facilities provide intensive but relatively brief residential treatment. Most short term residential treatment facilities consist of a 3 to 6 week inpatient treatment phase followed by a lengthy outpatient therapy and participation in self help groups.

Residential treatment is usually offered in a safe, empowering setting that gives dignity and respect to the patient, while challenging them in the first steps toward recovering from their addictions. Patients will receive intensive treatment, including education, counseling, goal based treatment, and relapse prevention groups.

Outpatient Treatment

Outpatient drug rehabilitation is a lower intensity and more cost effective alternative to the long term residency programs. They are complete, varied, and highly specific programs created to address drug addiction problems of individuals while remaining in their homes. They are based more on education than therapy. Outpatient drug rehabilitation is recommended for those individuals who need a support system. Outpatient drug rehabilitation is usually split into outpatient individual therapy, family therapy, and group therapy. Outpatient programs include problem-solving, insight oriented psychotherapy, cognitive behavioral therapy, 12-step programs, and other various types of therapy.

Outpatient drug rehabilitation team will usually contain psychiatrists, doctors, nurses, social workers and lawyers. The assistance of family and friends will greatly accelerate the recovery process. Treatment for teenagers always requires parental involvement. Outpatient drug rehabilitation will teach the family how to create a better home environment for a more successful recovery. In addition to being present for class at a facility, patients are usually required to attend 12 step meetings and case management conferences.

The 12 Step Method

The 12 step method is composed of guiding rules for recovery from either addictive or behavioral issues. It was developed by Alcoholics Anonymous and is a tried and tested method for long term alcoholism and drug addiction recovery. It is an effective yet simplistic treatment that uses 12 steps for living life in an easier and more rewarding way. The main principle of the program is letting go of the past and dealing with problems as they arise and being aware of the positive success achieved each day.

Report highlights the successes of public health responses to this epidemic, but also warns of sharp rise in all drug overdose deaths

A new report provides an unprecedented look at the scope and nature of an epidemic of overdoses related to illegally produced (non-pharmaceutical) fentanyl -- an epidemic that ultimately killed at least 1,013 people within less than two years.  Published in the July 25 issue of the Centers for Disease Control and Prevention’s (CDC) Mortality and Morbidity Weekly Report (MMWR), Non-Pharmaceutical Fentanyl-related Deaths, Multiple States chronicles the steps public health and law enforcement authorities at the federal, state and local level took in identifying and responding to the problem, and notes how these measures could be applied to public health threats.

Fentanyl is a synthetic opioid medication that when properly manufactured and administered is an effective treatment for severe or chronic pain.  It is a very potent drug; however (30-50 times more potent than heroin), and can be extraordinarily dangerous when produced illicitly or used non-medically.  Non-pharmaceutical versions of fentanyl have not only been sold directly as street drugs, but have also been mixed in with other street drugs such as heroin and cocaine –sometimes with fatal consequences.  

An April 2006 spike in the number of drug overdoses in Camden, N.J., was reported to the Epidemic Information Exchange (EpiX), a communications network developed by the U.S. Centers for Disease Control and Prevention.  Similar reports of sudden increases in overdoses and deaths from other parts of the country led the CDC, the Office of National Drug Control Policy, the Substance Abuse and Mental Health Services Administration, the Drug Enforcement Administration, and other public health and law enforcement officials to launch a government-wide effort to investigate the problem and protect the public health.

Working closely with state and local authorities, experts from these agencies were able to determine that what were initially suspected to be heroin overdoses were actually overdoses related to illicit drugs containing non-pharmaceutical fentanyl.  Federal authorities immediately undertook a wide range of efforts to determine the source and extent of the problem – including epidemiologic studies to assess its origins.

Federal, state and local authorities simultaneously launched intensive outreach efforts throughout the medical and substance abuse treatment communities to alert people of the dangers.  Practical information and measures were also provided for helping prevent exposure to illicit fentanyl drugs and for treating those who had been exposed.  Thanks in large part to these efforts, the epidemic, which was determined to have begun around April of 2005, ended by March 2007.

“This MMWR report details the effective measures CDC, ONDCP, DEA, SAMHSA and others implemented to stem this epidemic, save countless lives and help address possible future outbreaks,” said SAMHSA Administrator Terry Cline, Ph.D. “It also highlights the very disturbing rise in overdose deaths related to both the abuse of street and prescription drugs, and the continuing need to address this dire problem.”

The report’s editorial notes point out that the non-pharmaceutical epidemic occurred against a backdrop of dramatic rises in deaths from drug overdoses.  For example, unintentional drug poisoning (primarily drug overdoses) deaths rose from 11,155 in 1999 to 22,448 in 2005 – an increase of more than 100 percent.  The editorial notes that many of these fatal overdoses involved the use of opioid prescription drugs.
  
In light of this public health problem, the report recommends building upon many of the measures put in place to address the non-pharmaceutical fentanyl epidemic, including enhancing mechanisms for identifying and reporting drug-related deaths, establishing national standards for guiding the toxicological testing and analysis of these deaths and maintaining outreach programs for effectively providing vital information to potentially affected communities.

Youth Substance Abuse Declines from 2002 to 2007

Cocaine and methamphetamine use among young adults has dropped significantly over the past year, while abuse of prescription drugs has risen, according to the nation’s largest substance use assessment, the 2007 National Survey on Drug Use and Health (NSDUH). The report also showed a spike in drug use among 55-59 year-olds, as baby boomers entered that age range.

Cocaine use among 18-25 year-olds dropped 23 percent (to 1.7 percent), while methamphetamine use among young adults fell by a third (to 0.4 percent) between 2006 and 2007, said the report by the Substance Abuse and Mental Health Services Administration (SAMHSA). The survey was released today at the start of the 19th annual National Alcohol and Drug Addiction Recovery Month.

Historically, young adults have had the highest rates of substance abuse.

Among youth ages 12-17, there was a significant decline in overall past month illicit drug use, from 11.6 percent in 2002 to 9.5 percent in 2007. Reductions in youth drug use occurred for nearly every type of illicit drug, including marijuana, cocaine, hallucinogens, LSD, Ecstasy, prescription-type drugs used nonmedically, pain relievers, stimulants and methamphetamine.

Current marijuana use among this age group declined from 8.2 percent in 2002 to 6.7 percent in 2007. Most of the decline occurred between 2002 and 2005.

The level of alcohol use also dropped among those aged 12 to 17, from 17.6 percent in 2002 to 15.9 percent in 2007.  Similarly, the rate of cigarette use among this age group diminished from 13.0 percent in 2002 to 9.8 percent in 2007.

“These results confirm that progress has been made – particularly regarding substance abuse among younger Americans,” said HHS Secretary Mike Leavitt. “The report also reminds us of the importance of our efforts to provide substance abuse treatment to those in need and to encourage health care professionals to identify people who are at risk for developing substance abuse problems and intervene early.”

The reductions in methamphetamine and cocaine use among young adults coincide with reductions in their use among Americans in the workforce and significant market disruptions for both drugs.  In 2007, there was a 21 percent increase in the average price per gram for cocaine and a 10 percent decrease in purity. 

Workplace drug test positives for cocaine dropped 19 percent in 2007 to the lowest levels in the history of this testing system.  For methamphetamine, there has been a 50 percent reduction in the level of workplace drug test positives since 2005, along with an 84 percent increase in average price per pure gram and 26 percent decrease in methamphetamine purity in 2007.

Despite many positive trends, the most recent NSDUH also reveals some less encouraging data.  Among young adults ages 18 to 25, the level of current nonmedical use of prescription pain relievers has risen 12 percent (to 4.6 percent in 2007).  In addition, the level of current illicit drug use among those aged 55 to 59 more than doubled, to 4.1 percent in 2007, confirming concerns that baby boomers have continued their higher levels of substance abuse as they age.

“Our efforts against methamphetamine, cocaine, and other illegal drugs are working,” said John Walters, director of National Drug Control Policy.  “The markets for these poisons are shrinking, and the deadly grip they hold on the lives of individuals, families, and communities is being countered.  But when it comes to prescription drugs, we can not afford to re-live the painful experiences we’ve had with illegal drugs.  We must act quickly to increase awareness of the dangers of prescription drug abuse, decrease the illegal diversion of these products, and shore up safer practices for their prescription and distribution.”   

The 2007 NSDUH report also provides extensive data on mental health issues.  The report says 24.3 million Americans aged 18 or older experienced serious psychological distress over the past year, and 16.5 million Americans had suffered at least one major depressive episode during this period.

The mental health and substance abuse components of the report also highlight the association between these public health problems.  For example, in 2007 adults 18 and older who had experienced a major depressive episode in the past year were more than twice as likely as other adults to have used illicit drugs during that time (27.4 percent vs.12.8 percent).

“The survey shows the tremendous progress communities, families and individuals across America have made in reducing substance abuse among young people”, said  SAMHSA Acting Administrator  Eric Broderick, D.D.S, M.P.H, a rear admiral in the U.S. Public Health Service. “It also provides critical information that will help guide the future direction of our substance abuse prevention and treatment efforts.’’  

NSDUH is a scientifically conducted annual survey of approximately 67,500 people throughout the country.  Because of its statistical power, it is a primary source of information on the levels of illicit drug, alcohol, and tobacco use as well as certain mental health conditions.