Impulsivity May Trigger Addiction, Researchers Say

British researchers say that impulsivity seems to trigger addiction and not the other way around, Science magazine reported June 6.

People with addictions are known to be more impulsive and engage in more thrill-seeking behaviors than non-addicts, but it has been unclear whether those behaviors predated drug use or were the result of addiction.

Researchers David Belin and Barry Everitt of the University of Cambridge attempted to answer the question by studying rats known to have thrill-seeking or impulsive personalities. The researchers connected the rats to a device that delivered cocaine directly to their brains and then gave the rats control over their drug use. They found that the thrill-seeking rats tried the drug immediately and in high doses, while the impulsive rats used the drug less quickly and in greater moderation.

However, the authors found that after 40 days of access to the drug the impulsive rats had become addicted and could not stop using cocaine even when punished with an electric shock, while the thrill-seeking rats had grown tired of the drug and stopped using.

The research study is published in the June 6, 2008 edition of Science magazine.

See also;

• 12-Step Treatment More Effective than Alternative
• AA and Treatment Work Better Together
• Abstinence from Heroin Addiction Works
• Subscribe to BriefTSF by e-Mail

Theory and Practice of Group Counseling by Gerald Corey Read more about this title…

One cannabis joint is as bad as five cigarettes

RESEARCH CONFIRMS CANNABIS POSES SERIOUS HEALTH RISK TO LUNGS

The British Lung Foundation welcomes research published in the journal Thorax highlighting the dangers cannabis poses to the lungs.

“This research confirms that cannabis poses a serious health risk to the lungs and smoking a joint can be more harmful to the lungs than smoking a cigarette”, says Dr Keith Prowse, Chairman of the British Lung Foundation. “It’s important to remember, though, that tobacco continues to be more harmful overall because it is typically smoked in much higher quantities than cannabis.”

One of the reasons a cannabis joint can be more dangerous than a cigarette is that people tend to inhale the smoke more deeply as well as then holding it in for longer.

Reuters reported that smoking one cannabis joint is as harmful to a person’s lungs as having up to five cigarettes, according to research published on Tuesday.

Those who smoked cannabis damaged both the lungs’ small fine airways, used for transporting oxygen, and the large airways, which blocked air flow, the researchers said.

It meant cannabis smokers complained of wheezing, coughing, and chest tightness, the study by experts at the Medical Research Institute of New Zealand found.

The study found only those who smoked tobacco suffered from the crippling lung disease emphysema, but cannabis use stopped the lungs working properly.

"The extent of this damage was directly related to the number of joints smoked, with higher consumption linked to greater incapacity," said the authors of the report published in the medical journal Thorax.

"The effect on the lungs of each joint was equivalent to smoking between 2.5 and five cigarettes in one go."

“The danger cannabis poses to respiratory health is consistently being overlooked,” says Dame Helena Shovelton, Chief Executive of the British Lung Foundation. “Smoking a joint is more harmful to the lungs than smoking a cigarette and we have just banned people from doing that in public places because of the health risks.”

In a 2002 report, the British Lung Foundation estimated that three to four cannabis cigarettes a day were associated with the same amount of damage to the lungs as 20 or more tobacco cigarettes a day. The British Lung Foundation also called for more awareness of the issue.

The BLF are calling for:

• A public health campaign to make young people fully aware about the increased risk of lung infections and respiratory cancers
• Further research into potential links between cannabis smoking and Chronic Obstructive Pulmonary Disease (COPD) - an umbrella term for conditions including emphysema and chronic bronchitis.

Research; Sarah Aldington, Mathew Williams, Mike Nowitz, Mark Weatherall, Alison Pritchard, Amanda McNaughton, Geoffrey Robinson and Richard Beasley. THE EFFECTS OF CANNABIS ON PULMONARY STRUCTURE, FUNCTION AND SYMPTOMS. Thorax, July 2007.

The Co-Occurring Center for Excellence. Addressing mental disorders and alcoholism, addiction co-occurring.

The Co-Occurring Center for Excellence (COCE) was created by SAMHSA in 2003 to provide information and a range of services to mental health and substance abuse administrators and policymakers at state and local levels, their counterparts in tribal and Native populations, clinical providers, other providers, and all other agencies and systems through which clients may enter the treatment system.

COCE provides state-of-the-art and sustainable technical assistance, training, information and resources, and links to other resources that serve persons with co-occurring disorders.

http://www.coce.samhsa.gov/

See also;

• Double Trouble in Recovery
• Dual Diagnosis Anonymous
• Double Trouble in Recovery for Alcoholics
• 12-Step Treatment More Effective than Alternative

The Dual Diagnosis Recovery Sourcebook : A Physical, Mental, and Spiritual Approach to Addiction with an Emotional Disorder by Dennis Ortman Read more about this title…

Antidepressant Induced Mania (ADM) Among People with Co-Occurring Disorders (COD). Sometimes, informally called Bipolar III disorder.

A recent study of medical charts at a bipolar specialty clinic gives new support to the idea that antidepressants can induce mania in some bipolar patients.

For some time, clinicians have been concerned about the problem of antidepressant-induced mania (ADM), but most research has not supported the connection between antidepressants and manic or hypomanic episodes.

This study looked at ADM and examined differences between patients with bipolar disorder and a substance use disorder (SUD) and patients without SUD.

The article presents solid evidence for a significantly increased risk of ADM in patients with co-occurring bipolar disorder and SUD. The article also comments about why the increased risk to these clients may not have been identified in prior research.

Manwani and colleagues investigated medical charts from 98 patients who were treated at a bipolar clinic between 2000 and 2004. These patients accounted for 335 antidepressant trials during that period. Of the sample, 55 patients (accounting for 184 of the trials) had a lifetime history of a SUD.

For this study, an episode of ADM was defined as hypomanic or manic symptoms within 12 weeks of beginning a new antidepressant medication.

There were some substantial differences between patients who did and did not have a SUD history—e.g., clients with SUD were almost twice as likely as those without SUD to be prescribed lithium (48.3% vs. 28.5%), and clients without SUD were twice as likely to receive divalproex as those with SUD (43% vs. 20.1%) and almost three times as likely to be prescribed an antipsychotic (31.8% vs. 11.4%).

The univariate analysis of differences in the number of antidepressant trials leading to ADM between patients with and without a SUD history showed little difference in the percentage of ADM episodes they experienced (20.7% of trials for those with SUD and 21.4% of trials for those without).

However, using a multivariate regression model of analysis, the authors found that:

• Patients with a lifetime SUD were five times as likely to experience ADM,
• The incidence of an antidepressant trial leading to an ADM was greater for clients with Type II or with bipolar disorder not otherwise specified than for Type I,
• Females were more likely than males to have an episode of ADM in response to an antidepressant trial, and
• Bupropion was the antidepressant least likely to cause an ADM.

The authors surmise that older research studies excluding people with a SUD might have led to subject pools that underrepresented individuals considerably more likely to experience an ADM than the subjects studied. Additionally, they describe how other confounding factors might have served to hide the effects of having a history of SUD on the likelihood of suffering an ADM.

A discussion of the limitations of their study (e.g., it was non-randomized, non-blind; concomitant therapy may have obscured treatment effect; no measures of adherence to medication regimens) is also given.

Research; Manwani, S. G., Pardo, T. B., Albanese, M. J., Zablotsky, B., Goodwin, F. K., & Ghaemi, S. N. (2006). Substance use disorder and other predictors of antidepressant-induced mania: a retrospective chart review. Journal of Clinical Psychiatry, 67(9), 1341–1345.

Co-Occurring Disorders Research and Resources Monthly Review. The Co-Occurring Center for Excellence (COCE), of the Substance Abuse and Mental Health Services Administration (SAMHSA), Vol. 1, No. 5, December 2006. Readers interested in finding out more about COCE should visit the Web site: http://coce.samhsa.gov/

See also;

• Double Trouble in Recovery
• Double Trouble in Recovery for Alcoholics
• Dual Recovery Anonymous
• Dual Diagnosis Anonymous
• Subscribe to BriefTSF by e-Mail

Dual Diagnosis, Counseling the Mentally Ill Substance Abuser by Katie Evans, J. Michael Sullivan Read more about this title…

Students with a dense family history of alcoholism are most at risk of alcohol-use disorders

This study looks at first-, second- and third-degree relatives instead of just one parent, usually paternal

Not all university students will “mature out” of their heavy-drinking habits.

A new study examines the density of college students’ family history of alcoholism.

This type of measure – looking at first-, second- and third-degree relatives – identified a significant number of at-risk individuals who would have been missed using regular family-history measures.

While many university students tend to “mature out” of heavy-drinking behavior by the time they become young adults, some go on to develop alcohol-use disorders (AUDs). Most genetic research on an individual’s family history of alcoholism (FHA) has looked at the parents’ – usually paternal – alcohol use. New findings indicate that looking at the density of FHA – including first-, second- and third-degree relatives – is much more telling.

Results will be published in the August issue of Alcoholism: Clinical & Experimental Research.

“Using a density measure of FHA can identify a greater number of individuals who may be at risk for developing an alcohol problem,” said Christy Capone. “The greater number of affected relatives … the greater the potential risk of developing an AUD. Ours is the first published study to examine this measure among college students.”

“Family density appears to be a promising method to identify a higher percentage of at-risk individuals,” agreed John Hustad, research associate at Brown University. “For example, in this study, approximately 44 percent of the at-risk participants would have been missed if a typical family-history measure had been used instead of the family-history density approach.”

The study population for this research consisted of 408 undergraduate students (293 females, 115 males) from a northeastern U.S. university who were asked to complete an anonymous survey for course credit during the 2005-2006 academic year.

“Our use of a density measure identified a large proportion of students, about 29 percent, who are at potentially greater risk for development of AUDs based on their report of alcoholism among first- and second-degree relatives,” said Capone. “Our other key finding was the relationship between FHA and other potential risk factors – behavioral undercontrol, age of onset of drinking (AOD), and cigarette use.”

All of these risks factors are inter-related, added Hustad. “First, family-history density was related to AOD, behavioral undercontrol, and current cigarette use which, in turn, are related to alcohol use and/or alcohol-related problems in this sample of college students. Second, behavioral undercontrol was associated with alcohol problems but not the degree of alcohol consumption; this suggests that individuals with a family-history density of AUDs and behavioral undercontrol are more likely to behave irresponsibly when drinking.”

“The importance of identifying these risk factors is the idea that they can be useful markers of at-risk status and can help us to develop appropriate intervention strategies,” said Capone. “Although, given the fact that many students come to college already having experience with alcohol, I believe that preventive interventions should begin early in the high-school years or during the transition from middle school to high school.”

Hustad agreed. “Due to the relationship between earlier AOD and more alcohol-related problems during college, it is clear that education and prevention efforts should begin well before the college years,” he said. “Until that happens, the risk factors identified in this research can be easily implemented in any screening and brief intervention for incoming college students. For example, these results suggest that effective interventions addressing tobacco use may have a positive influence on both smoking and alcohol-related consequences.”

“It is important to remember that not everyone with density of familial alcoholism will go on to develop a long-term problem with alcohol themselves,” said Capone. “Alcohol dependence is a very complex disorder and FHA is but one influence on its development. However, college students who are heavy drinkers and have a greater density of familial alcoholism are certainly at higher risk of continuing to drink in a problematic fashion after the college years.”

See also;

• 12-Step Treatment More Effective than Alternative
• AA and Treatment Work Better Together
• AA Offers Recovery Not Religion
• Twelve Step Facilitation
• Subscribe to BriefTSF by e-Mail

Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism by AA Services Read more about this title…

• Alcohol Related Brain Injury
• Adolescent Children of Alcoholics
• Alcoholic jealousy
• Alcoholics Anonymous with Narcotics Anonymous
• ALCOHOLISM MYTHS
• Anti-craving Naltrexone Injection Reduces Drinking
• Brief-TSF Description
• Brief-TSF is Holistic Treatment
• Client Impressions About Alcoholics Anonymous
• Comparison of Addiction Treatment
• Counselor Characteristics
• Dentists and Alcohol and Drug Use
• Free Inhalant Abuse Education
• Inappropriate Treatment for Alcohol Withdrawal is Common
• Predictors of Relapse in Alcoholism
• Prescription Drug Overdose Becomes Big Killer
• Sleep, PTSD and Alcoholism
• Spiritual Assessment
• Sweet Tooth and Alcoholism
• Teen Drinking Leads to Risk of Alcoholism
• The Dry Drunk
• Thyroid Function in Depression and Alcohol Abuse
• Training; Domestic Violence and Substance Abuse
• TSF Description
• Twelve Steps to Recovery from Burnout
• Subscribe to BriefTSF by e-Mail

Cannabis use and risk of psychotic or affective mental health outcomes

Background; Whether cannabis can cause psychotic or affective symptoms that persist beyond transient intoxication is unclear. We systematically reviewed the evidence pertaining to cannabis use and occurrence of psychotic or affective mental health outcomes.

Methods; We searched databases from their inception to September, 2006, searched reference lists of studies selected for inclusion, and contacted experts. Studies were included if longitudinal and population based. 35 studies from 4804 references were included. Data extraction and quality assessment were done independently and in duplicate.

"we conclude that there is now sufficient evidence to warn young people
that using cannabis could increase their risk of developing a psychotic illness later in life."

Findings; There was an increased risk of any psychotic outcome in individuals who had ever used cannabis (pooled adjusted odds ratio=1·41, 95% CI 1·20-1·65). Findings were consistent with a dose-response effect, with greater risk in people who used cannabis most frequently (2·09, 1·54-2·84). Results of analyses restricted to studies of more clinically relevant psychotic disorders were similar. Depression, suicidal thoughts, and anxiety outcomes were examined separately. Findings for these outcomes were less consistent, and fewer attempts were made to address non-causal explanations, than for psychosis. A substantial confounding effect was present for both psychotic and affective outcomes.

Interpretation; The evidence is consistent with the view that cannabis increases risk of psychotic outcomes independently of confounding and transient intoxication effects, although evidence for affective outcomes is less strong. The uncertainty about whether cannabis causes psychosis is unlikely to be resolved by further longitudinal studies such as those reviewed here. However, we conclude that there is now sufficient evidence to warn young people that using cannabis could increase their risk of developing a psychotic illness later in life.

Theresa HM Moore, Stanley Zammit, Anne Lingford-Hughes, Thomas RE Barnes, Peter B Jones, Margaret Burke and Glyn Lewis. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. The Lancet 2007; 370:319-328

Life With Hope: A Return to Living Through the Twelve Steps and Twelve Traditions of Marijuana Anonymous

Prevalence of positive substance abuse screen results among adolescent primary care patients

Objectives; To measure the prevalence of positive substance use screen results among adolescent primary care patients and to estimate the prevalence of substance-related problems and disorders.

Results; Overall, 14.8% of adolescents had positive results on the CRAFFT screen.

Prevalence rates differed significantly across practices (P < .001) after adjusting for demographic factors.

The highest positive rates on the CRAFFT screen were at

• School-based health centers (29.5%) and
• Rural family practice (24.2%),
• Middle rate was at the adolescent clinic (16.6%), and
• Lowest rates were at the health maintenance organization (14.1%) and
• Pediatric clinic (8.0%).
• Sick visits had the highest rate (23.2%).
• Well-child care visits had a significantly lower rate (11.4%, P < .001).

Statistical modeling estimated that 11.3% of all patients had problematic use,

• 7.1% had abuse, and
• 3.2% had dependence.

Conclusion; Substance abuse screening should occur whenever the opportunity arises, not at well-child care visits only.

Arch Pediatr Adolesc Med. 2007;161(11):1035-1041.

Teens Under the Influence: The Truth About Kids, Alcohol, and Other Drugs- How to Recognize the Problem and What to Do About It by Katherine Ketcham Read more about this title…

Course Overview: This course will define and discuss inhalant abuse, with particular concentration on how to recognize the manifestations of abuse.

This course is intended for nurses in all areas of healthcare, and health professionals in acute care settings.

Upon completion of this course, the learner should be able:

• Define inhalants.
• Identify classes and examples of inhalants.
• Recognize reasons why youths are using inhalants.
• Describe the characteristics of a youth likely to start using.
• Recognize Inhalant research regarding gender and ethnicity.
• Describe methods of Inhalation and the most frequent site of usage.
• Describe the effects of inhalants on the body.
• Define inhalant intoxication, withdrawal, tolerance and addiction.
• Describe the assessment process.
• Identify emergency treatment.
• Recognize fatal and long-term consequences of Inhaling.
• Correlate the relationship of Inhalant abuse and delinquent behavior.
• Describe keys to prevent Inhalant abuse.

What are Inhalants?

Inhalants are breathable chemical vapors that produce psychoactive (mind-altering) effects. While we are commonly exposed to volatile solvents and other inhalants in the home and workplace, most of us are unaware that these substances can be inhaled as drugs. This is probably because most inhalants were not designed to be used that way and because normal use results in low inhaled concentration.

Inhalants are often called “Gateway Drugs” because they lead to use of other drugs, such as marijuana and methamphetamines. Sometimes the chemical itself becomes the drug of choice and is abused into adulthood. Healthcare professionals and the public generally lack awareness of the toxic effects of inhalants and do not consider that household products could be addicting.

Course is available at; http://www.rnceus.com/course_frame.asp?exam_id=47&directory=inhal

A NATURALISTIC COMPARISON OF OUTCOMES AT SOCIAL AND CLINICAL MODEL SUBSTANCE ABUSE TREATMENT PROGRAMS.

Since the 1970s, much of the public treatment system in California has been based on a social model orientation to recovery for alcoholics, but there has been minimal research on program outcomes. This article reports on follow-up interviews conducted with a representative sample of 722 people who had entered treatment about a year earlier in public and private programs, including publicly-funded social model detoxification and residential programs, and clinical model programs in hospitals and HMO clinics.

higher levels of 12-step program involvement during follow-up, which strongly predicted an absence of alcohol problems

• Social model clients came to treatment with more severe legal and employment problems, whereas those seeking treatment at clinical programs reported more severe family problems.
• At follow-up, clients at both types of programs reported attending a similar number of Alcoholics Anonymous (AA) meetings, but social model clients reported going to more Narcotics Anonymous (NA) meetings and being involved in more AA activities.
• Social model clients were less likely than clinical model clients to report problems with alcohol or drugs at follow-up, but the odds of reporting other problems (e.g., medical, psychological, legal, family/social) were similar.

The program effect for better alcohol outcomes at the social model programs was partially explained by their clients’ higher levels of 12-step program involvement during follow-up, which strongly predicted an absence of alcohol problems.

• Social networks supportive of abstinence also were predictive of reporting no alcohol problems at follow-up.

In contrast, subsequent detoxification treatment events between baseline and follow-up were associated with a higher odds of reporting alcohol, drug, psychiatric and family/social problems at follow-up.

These findings are consistent with the growing body of literature reporting higher rates of abstinence among those who are able to construct more positive social networks, and who attend and become involved in 12-step programs during and following treatment.

It is important that these results be replicated, as they suggest that social model programs are successful in engaging their clients in AA activities and in NA meeting attendance, and could represent for some an effective alternative to clinical model treatment programs.

Research; LEE ANN KASKUTAS, LYNDSAY AMMON, CONSTANCE WEISNER. A NATURALISTIC COMPARISON OF OUTCOMES AT SOCIAL AND CLINICAL MODEL SUBSTANCE ABUSE TREATMENT PROGRAMS. International Journal of Self Help and Self Care; Volume 2, Number 2 / 2003-2004, 111 - 133

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