Parents who try to teach responsible drinking by letting their teenagers have alcohol at home may be well intentioned, but they may also be wrong, according to a new study in the latest issue of the Journal of Studies on Alcohol and Drugs.

In a study of 428 Dutch families, researchers found that the more teenagers were allowed to drink at home, the more they drank outside of home as well. What’s more, teens who drank under their parents’ watch or on their own had an elevated risk of developing alcohol-related problems.

Drinking problems included trouble with school work, missed school days and getting into fights with other people, among other issues.

The findings, say the researchers, put into question the advice of some experts who recommend that parents drink with their teenage children to teach them how to drink responsibly — with the aim of limiting their drinking outside of the home.

That advice is common in the Netherlands, where the study was conducted, but it is based more on experts’ reasoning than on scientific evidence, according to Dr. Haske van der Vorst, the lead researcher on the study.

“The idea is generally based on common sense,” says van der Vorst, of Radboud University Nijmegen in the Netherlands. “For example, the thinking is that if parents show good behavior — here, modest drinking — then the child will copy it. Another assumption is that parents can control their child’s drinking by drinking with the child.”

But the current findings suggest that is not the case.

Based on this and earlier studies, van der Vorst says, “I would advise parents to prohibit their child from drinking, in any setting or on any occasion.”

The study included 428 families with two children between the ages of 13 and 15. Parents and teens completed questionnaires on drinking habits at the outset and again one and two years later.

The researchers found that, in general, the more teens drank at home, the more they tended to drink elsewhere; the reverse was also true, with out-of-home drinking leading to more drinking at home. In addition, teens who drank more often, whether in or out of the home, tended to score higher on a measure of problem drinking two years later.

The findings, according to van der Vorst, suggest that teen drinking begets more drinking — and, in some cases, alcohol problems — regardless of where and with whom they drink.

“If parents want to reduce the risk that their child will become a heavy drinker or problem drinker in adolescence,” she says, “they should try to postpone the age at which their child starts drinking.”

van der Vorst, H., Engels, R. C. M. E., & Burk, W. J. (January 2010). Do parents and best friends influence the normative increase in adolescents’ alcohol use at home and outside the home? Journal of Studies on Alcohol and Drugs, 71 (1), 105-114.

Available at: jsad/jsad/link/71/105

Source:
Haske van der Vorst
Journal of Studies on Alcohol and Drugs

In an article appearing in the May 5 issue of the Journal of the American Medical Association (JAMA), addiction researchers at the National Institutes of Health compared marijuana use in the U.S. adult population in 1991-92 and 2001-02.

They found that the number of people reporting use of the drug remained substantially the same in both time periods, but the prevalence of marijuana abuse or dependence increased markedly. This new study showed that increases in the prevalence of abuse or dependence were most notable among young African-American men and women and young Hispanic men.

This is the first study to assess long-term trends in marijuana abuse and dependence in the United States using the most up-to-date classification system-the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).

The researchers from the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) compared trends in marijuana use, abuse, and dependence using the DSM-IV categories.

The DSM defines marijuana abuse as repeated instances of use under hazardous conditions; repeated, clinically meaningful impairment in social/occupational/educational functioning; or legal problems related to marijuana use. Marijuana dependence is defined as increased tolerance, compulsive use, impaired control, and continued use despite physical and psychological problems caused or exacerbated by use.

“Marijuana is the most commonly used illegal substance in the United States, and its use is associated with educational underachievement, reduced workplace productivity, motor vehicle accidents, and increased risk of use of other substances,” says NIDA Director Dr. Nora D. Volkow.

“This study suggests that we need to develop ways to monitor the continued rise in marijuana abuse and dependence and strengthen existing prevention and intervention efforts, particularly developing and implementing new programs that specifically target African-American and Hispanic young adults.”

Dr. Wilson Compton, Director of the Division of Epidemiology, Services and Prevention Research at NIDA, Dr. Bridget Grant at NIAAA, and their colleagues evaluated data from two large, national epidemiologic surveys conducted 10 years apart – the National Longitudinal Alcohol Epidemiologic Survey (NLAES) and the National Epidemiological Survey on Alcohol and Related Conditions (NESARC).

A total of 42,862 men and women ages 18 years and older participated in the 1991-1992 NLAES study, which was conducted by the NIAAA under the leadership of Dr. Grant. She was also the principal architect for the 2001-2002 NESARC study, which included 43,093 similarly aged men and women. Both surveys included the same core questions to assess marijuana use, abuse, and dependence.

“The value of well-designed and well-executed epidemiologic studies is that they point to where problems exist and where additional research and resources must be directed. In addition to the findings about marijuana, we look forward to learning more about alcohol disorders – indeed, about other mental health disorders, as well – from the same data set,” explains Dr. Ting-Kai Li, Director, NIAAA.

“The results of our study show that use of marijuana remained stable in 2001-2002 compared to 1991-1992; however, there were significant increases in marijuana abuse or dependence, especially in certain minority subgroups,” says Dr. Compton.

“Overall, marijuana abuse or dependence rose by 22 percent from 1991-1992 to 2001-2002. This means that there were approximately 800,000 more adults in the United States with marijuana abuse or dependence in 2001-2002. Furthermore, marijuana abuse or dependence was more common among Whites than among minorities in 1991-1992, but by 2001-2002 the differences in abuse and dependence rates among the different ethnic groups had narrowed considerably. This change was due to increases of 224 percent among young African-American men and women aged 18-29, and 148 percent among young Hispanic men aged 18-29.”

The increase in potency of marijuana over the last decade may be partly responsible for the drug’s increased abuse and dependence, particularly since marijuana use patterns have not changed over this period. However, no single factor can account entirely for the increases seen in minority populations, the authors report. Numerous cultural, psychosocial, economic, and lifestyle factors likely play roles.

The National Institute on Drug Abuse is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports more than 85 percent of the world’s research on the health aspects of drug abuse and addiction.

The Institute carries out a large variety of programs to ensure the rapid dissemination of research information and its implementation in policy and practice. Fact sheets on the health effects of drugs of abuse and information on NIDA research and other activities can be found on the NIDA home page at drugabuse.

The National Institute on Alcohol Abuse and Alcoholism, a component of the National Institutes of Health, U.S. Department of Health and Human Services, conducts and supports approximately 90 percent of the U.S. research on the causes, consequences, prevention, and treatment of alcohol abuse, alcoholism, and alcohol problems and disseminates research findings to science, practitioner, policy making, and general audiences. Additional alcohol research information and publications are available at niaaa.nih.

NIDA CONTACT:
Blair Gately
301-443-6245

Contacto NIDA en Espa?ol:
Sara Rosario
301-594-6145

NIAAA CONTACT:
Ann Bradley
301-443-3860

Personality traits associated with chronic worrying can lead to earlier death, at least in part because these people are more likely to engage in unhealthy behaviors, such as smoking, according to research from Purdue University.

“Research shows that higher levels of neuroticism can lead to earlier mortality, and we wanted to know why,” said Daniel K. Mroczek, (pronounced Mro-ZAK) a professor of child development and family studies. “We found that having worrying tendencies or being the kind of person who stresses easily is likely to lead to bad behaviors like smoking and, therefore, raise the mortality rate.

“This work is a reminder that high levels of some personality traits can be hazardous to one’s physical health.”

Chronic worrying, anxiety and being prone to depression are key aspects of the personality trait of neuroticism. In this study, the researchers looked at how smoking and heavy drinking are associated with the trait. A person with high neuroticism is likely to experience anxiety or depression and may self-medicate with tobacco, alcohol or drugs as a coping mechanism.

They found that smoking accounted for about 25 percent to 40 percent of the association between high neuroticism and mortality. The other 60 percent is unexplained, but possibly attributed to biological factors or other environmental issues that neurotic individuals experience, Mroczek said.

The researchers analyzed data of 1,788 men and their smoking behavior and personality traits over a 30-year period from 1975 to 2005. The data was part of the VA Normative Aging Study, which is a long-term study of aging men based at the Boston VA Outpatient Clinic.

Mroczek and his co-authors, Avron Spiro III and Nicholas A. Turiano, published their findings in this month’s Journal of Research in Personality.

A better understanding of the bridge between personality traits and physical health can perhaps help clinicians improve intervention and prevention programs, Mroczek said.

“For example, programs that target people high in neuroticism may get bigger bang for the buck than more widespread outreach efforts,” he said. “It also may be possible to use personality traits to identify people who, because of their predispositions, are at risk for engaging in poor health behaviors such as smoking or excessive drinking.”

The National Institute on Aging and the U.S. Department of Veterans Affairs supported this work.

Source:
Amy Patterson Neubert

Purdue University

Alcohol triggers the activation of a variety of genes that can influence the health and activity of brain cells, and new research from Weill Cornell Medical College in New York City sheds light on how that process occurs.

The findings, published in the Nov. 21 issue of The Journal of Neuroscience, may also edge scientists closer to understanding alcohol linked disorders such as the brain damage associated with chronic alcoholism, and the abnormal brain development seen in the fetal alcohol syndrome (FAS).

“If you are going to understand the biological effects of alcohol on genes within cells, you have to understand the molecular machinery driving the transcription, or activation, of the genes in question. That’s what we believe we have done here,” says the study’s senior author Dr. Neil L. Harrison, professor of pharmacology and pharmacology in anesthesiology at Weill Cornell.

In research conducted in cell cultures and in mouse neurons in vivo, his team found that alcohol stimulates a ubiquitous, stress-linked biochemical cascade — called the heat shock pathway — to send a molecule called heat shock factor 1 (HSF1) into the neuron’s nucleus. HSF1 then stimulates the transcription of many of the genes known to be activated by alcohol.

The fact that alcohol triggers the activation of genes in the brain is not new and has long been the subject of intense research.

One gene in particular, called Gabra4, is closely linked to the function (or dysfunction) of receptors for GABA, an important neurotransmitter.

“We knew that levels of expression of Gabra4 fluctuated rapidly in the presence of alcohol, and so we wondered if we could find out how this happens,” says lead author Dr. Leonardo Pignataro, instructor in pharmacology in anesthesiology at Weill Cornell.

At the same time, research in Korea with the C. elegans worm (a common tool for genomics research) had discovered that alcohol worked on a particular bit of DNA to trigger activity in the heat shock pathway, finding the same piece of DNA in the Gabra4 gene of mice and humans. “This was all very intriguing, because the heat shock pathway is a biochemical mechanism found in almost all cells and all organisms,” says Dr. Harrison. “Scientists believe it helps cells deal with stressors — including excessive heat or environmental toxins — substances such as alcohol.”

Working with mouse cells in the lab, the researchers used microarray technologies to search for genes other than Gabra4 that might be activated when the heat shock pathway was exposed to alcohol. They found many others.

“The big question that remains is how does this activation occur? The current theory holds that, under conditions of stress, heat shock proteins break away from a key molecule, HSF1. HSF1 then makes its way to the cell nucleus, where it helps stimulate the transcription and activation of a variety of genes that enable the cell to survive stress. We think this may happen with alcohol exposure,” Dr. Harrison explains.

This finding, observed in vitro in the cell cultures, was replicated in in vivo experiments in mice, conducted in the lab of Dr. Daniel Herrera, assistant professor of psychiatry at Weill Cornell and an attending psychiatrist at NewYork-Presbyterian/Weill Cornell.

“It was really exciting to see this mechanism work itself out in an animal model, suggesting that this same pathway may mediate at least some of the effects of alcohol on human brain cells,” Dr. Herrera says.

Exactly what those effects might mean clinically remains in the realm of speculation for now, the researchers stress.

“Alcohol can have bad effects — the well-known effects of alcoholism, such as liver or brain damage, for example — but moderate alcohol use also has more benign effects, such as the improvement in cardiovascular health observed in drinkers of red wine compared with tee-totallers,” Dr. Pignataro points out.

One theory holds that alcohol-mediated stimulation of the heat shock pathway might trigger genes that help mop up mis-folded proteins that can damage cells. This would be a beneficial effect.

“But it might also be possible that inappropriate activity of this pathway — either during fetal brain development or in the adult brain — is harmful. We just don’t know,” Dr. Harrison says. “We’d certainly like to explore these issues going forward, and this research will give us some tools to answer these questions.”

This research was funded by the U.S. National Institutes of Health and the Reader’s Digest Foundation.

Co-researchers include Alexandria N. Miller and Shonali Midha of Weill Cornell Medical College; Dr. Limei Ma, formerly of Dr. Harrison’s lab and now at The Stowers Institute for Medical Research, Kansas City; and Dr. Petr Protiva, of The Rockefeller University, New York City, and the University of Connecticut Health Center, Farmington.

Weill Cornell Medical College

Weill Cornell Medical College — Cornell University’s Medical School located in New York City — is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine, locally, nationally and globally. Weill Cornell, which is a principal academic affiliate of NewYork-Presbyterian Hospital, offers an innovative curriculum that integrates the teaching of basic and clinical sciences, problem-based learning, office-based preceptorships, and primary care and doctoring courses. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research in such areas as stem cells, genetics and gene therapy, geriatrics, neuroscience, structural biology, cardiovascular medicine, infectious disease, obesity, cancer, psychiatry and public health — and continue to delve ever deeper into the molecular basis of disease in an effort to unlock the mysteries behind the human body and the malfunctions that result in serious medical disorders. The Medical College — in its commitment to global health and education — has a strong presence in such places as Qatar, Tanzania, Haiti, Brazil, Austria and Turkey. With the historic Weill Cornell Medical College in Qatar, the Medical School is the first in the U.S. to offer its M.D. degree overseas. Weill Cornell is the birthplace of many medical advances — from the development of the Pap test for cervical cancer to the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., the first clinical trial for gene therapy for Parkinson’s disease, the first indication of bone marrow’s critical role in tumor growth, and, most recently, the world’s first successful use of deep brain stimulation to treat a minimally-conscious brain-injured patient. For more information, visit med.cornell.

NewYork Presbyterian Hospital
425 East 61st St., Fl. 7
New York, NY 10021
United States
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US WorldMeds, a Kentucky-based specialty pharmaceutical company, announced that a recently completed Phase III clinical trial investigating the use of lofexidine hydrochloride (Lofexidine) for the treatment of opiate withdrawal symptoms in patients undergoing opiate detoxification has shown that opiate-dependent patients taking the drug experienced a significant reduction in withdrawal symptoms at the anticipated peak of withdrawal and stayed longer in detoxification treatment as compared to patients taking placebo.

“The debilitating withdrawal symptoms associated with opiate detoxification are a major reason people struggling with heroin or prescription drug addiction avoid or leave treatment,” said Paul Breckinridge “Breck” Jones, CEO of US WorldMeds. “These trial results are impressive and confirm our expectations for Lofexidine. Lofexidine promises to be an important new tool for treating opiate addiction here in the US.”

Lofexidine is being developed as a non-addictive, non-narcotic treatment for relieving withdrawal symptoms associated with opiate detoxification. Opiates include the illicit drug heroin and prescription drugs such as oxycodone (e.g. OxyContin®) and hydrocodone (e.g. Vicodin®). Typical opiate withdrawal symptoms include vomiting, sweating, stomach cramps, diarrhea, and muscle pain.

If approved by the US Food and Drug Administration (FDA), Lofexidine would be the first non-addictive, non-narcotic treatment approved in the United States for relieving withdrawal symptoms associated with opiate detoxification. Currently, the only FDA-approved treatment options for opiate detoxification are medications such as methadone and buprenorphine, which are opiate derivatives and have addictive properties.

US WorldMeds initiated the randomized, double-blind Phase III clinical trial for Lofexidine in June 2006 as a collaborative effort between the company, the National Institute on Drug Abuse (NIDA) and the Department of Veterans Affairs (VA) Cooperative Studies Program Coordinating Center in Perry Point, MD. The trial was designed to evaluate the effectiveness of Lofexidine in reducing withdrawal symptoms in subjects undergoing opioid detoxification. Additionally, the trial sought to assess whether Lofexidine increased the number of patients who completed detoxification treatment, whether the drug was safe, and other secondary objectives.

The Phase III trial for Lofexidine involved 264 adult patients – 200 male and 64 female – who had a proven dependence on an opioid such as heroin, morphine, or oxycodone. Study subjects were admitted to one of 15 clinical trial sites throughout the United States for this eight-day, inpatient study. As a primary measure of effectiveness, the severity of the subjects’ withdrawal symptoms was evaluated using the Short Opiate Withdrawal Scale (SOWS-Gossop), a subjective assessment in which patients rate their individual withdrawal experiences. Study subjects were free to withdraw from the study at any time.

The statistical analysis of the primary efficacy endpoints of the Phase III trial is now complete. The initial results demonstrate Lofexidine’s statistical significance versus placebo in reducing withdrawal symptoms associated with opiate detoxification on the third day of treatment, which is the expected peak point for withdrawal symptoms. Also, patients taking Lofexidine in the trial stayed in detoxification treatment longer than patients taking placebo.

“This trial has shown that Lofexidine can both reduce peak withdrawal symptoms associated with opiate detoxification and help people remain in an opiate detoxification program such as the one studied,” said Dr. Charles Gorodetzky, Medical Director of US WorldMeds. “These benefits, combined with the fact that Lofexidine would be the first non-addictive, non-narcotic medication of its kind on the US market, make it a potentially important new tool in managing patients during the critical opiate withdrawal period.”

NIDA estimates that drug and alcohol addiction costs the United States greater than $500 billion each year in lost earnings, healthcare expenditures, and costs associated with accidents and crime. Opioid addiction, which includes the use of illegal drugs such as heroin and the non-medical use of medications such as methadone, morphine, oxycodone (e.g. OxyContin®) and hydrocodone (e.g. Vicodin®), impacts millions of American families annually. In the September 2007 National Survey on Drug Use and Health, the US Substance Abuse and Mental Health Services Administration (SAMHSA) reported that nearly 3.8 million Americans have used heroin in their lifetimes and that approximately 560,000 used the drug in 2006. The survey also showed that more than 4 million Americans have illicitly used OxyContin® in their lifetimes and that 1.3 million illicitly used the prescription medication in 2006.

Lofexidine, an alpha-2-adrenergic agonist, has been studied in six prior clinical trials in the United States. Lofexidine therapy is associated with common side effects including hypotension, bradycardia, dry mouth, and sedation.

Lofexidine has been approved for use for 15 years in the United Kingdom (UK) to manage the often debilitating withdrawal symptoms that occur during opiate detoxification. It is marketed in the UK by Britannia Pharmaceuticals as BritLofex®. US WorldMeds acquired a license for Lofexidine from Britannia in 2003.

Given the encouraging initial results of the Phase III clinical trial, US WorldMeds intends to submit a new drug application (NDA) for Lofexidine with the FDA for US approval. The NDA will be filed after the complete dataset from the trial, including additional efficacy and safety measures, is analyzed, and additional required studies are completed.

The following medical facilities were involved in the Phase III Lofexidine trial:

- Alexian Brother Behavioral Health Hospital, Hoffman Estates, IL
- Atlanta Center for Medical Research, Atlanta, GA
- Aurora Psychiatric Hospital, Wauwatosa, WI
- CNS Psychiatric Institute of Washington, Washington, D.C.
- Lake Charles Clinical Trials, LLC, Lake Charles, LA
- North Miami Research, Inc, North Miami, FL
- Providence VA Medical Center/ Ocean State Research Institute, Providence, RI
- Research Across America, Dallas, TX
- St. Vincent Catholic Medical Center & Richmond University Medical Center, Staten Island, NY
- University of Kentucky Center for Human Behavioral Science, Lexington, KY
- University of Texas Health Science Center, San Antonio, TX
- Vanderbilt Psychiatric Hospital, Nashville, TN
- VA Puget Sound Health Care System/ The Seattle Institute for Biomedical and Clinical Research, Seattle, WA
- VA Salt Lake City Healthcare System/ Western Institute of Biomedical Research, Salt Lake City, UT
- Wayne State Addiction Research Institute, Detroit, MI

About US WorldMeds

US WorldMeds is a closely held specialty pharmaceutical company based in Louisville, Kentucky. Founded in 2001, US WorldMeds is focused on identifying, developing and commercializing therapeutic treatments for niche patient populations.

US WorldMeds

View drug information on Oxycodone and Aspirin; OxyContin.

Nicotine addiction plagues millions. A group of Grinnell College researchers recently uncovered a “key” that may “unlock” proteins and guide efforts to develop treatments for nicotine addiction. The research, conducted by Grinnell biological chemistry students and led by Mark Levandoski, associate professor of chemistry, examined the family of proteins in the nervous system that respond to nicotine.

Levandoski’s team discovered that the proteins react to certain “keys,” and the new “lock” may provide new strategies for pharmaceutical companies to design drugs and an easier way to overcome nicotine addiction.

The National Institutes of Health and Research Corporation supported this protein research, and the findings were recently published in The Journal of Neuroscience. Levandoski is available for interviews to discuss this discovery in detail, including how it impacts drug design.

Source
Grinnell College

Journal of Psychopharmacology is proud to be publishing this leading research on the place of pharmacology in finding alternatives for alcohol. The following papers appear in the May 2006 issue:

Critique:

* Alcohol alternatives – a goal for psychopharmacology, by David J Nutt, University of Bristol, UK Commentaries:
* Alcohol alternatives – a goal for psychopharmacology, by Ian Ragan, CIR Consulting UK
* Harm reduction – lessons learned from tobacco control, by Marcus R Munaf, University of Bristol, UK
* For alcohol alternatives, the science is not the hardest part, by Robin Room, Stockholm University, Sweden
* The regulatory challenges in engineering a safer tipple, by Wayne Hall, University of Queensland, Australia

As Prof Nutt, Editor-in-Chief of Journal of Psychopharmacology, outlines in his piece, “Alcohol is a growing problem worldwide that some believe may have already overtaken tobacco in terms of overall health and social care costs because of the consequences of intoxication, such as accidents, with subsequent medical complications.”

These papers discuss alternative models to the current approach to the sale and consumption of alcohol, such as removing or reducing alcohol content in drinks sold, especially beers and lager, and offering tax incentives for low alcohol or alcohol-free drinks.

These papers also discuss the scope for further pharmacological investigation into a chemical that can be substituted for alcohol without leading to the same level of misuse and dependence. New partial agonists (PA) could be used that would allow the user to enjoy the pleasurable effects of alcohol consumption but without the associated ill effects, such as memory loss and impaired motor skills.

There would need to be legislative reform governing outlets offering these PAs, but as this could potentially hold the key to eradicating the problems currently associated with alcohol misuse, such legislative reform may well be well placed.

About The British Association of Psychopharmacology:
The British Association of Psychopharmacology was founded in 1974, with the general intention of bringing together those from clinical and experimental disciplines as well as members of the pharmaceutical industry involved in the study of psychopharmacology. To this end the Association arranges scientific meetings, fosters research and teaching, encourages publication of results of research and provides guidance and information to the public on matters relevant to psychopharmacology. bap/

About SAGE Publications:
SAGE Publications is a leading international publisher of journals, books, and electronic media for scholarly, educational, and professional markets. Since 1965, SAGE has helped inform and educate a global community of scholars, practitioners, researchers, and students.

Contact: Fiona Barratt
fiona.barrattsagepub.co
SAGE Publications

We’ve all been asked at routine visits to the doctor to record our family’s history with medical problems like cancer, diabetes or heart disease. But when it comes to mental disorders, usually mum’s the word.

New findings by researchers at the Duke Institute for Genome Sciences & Policy (IGSP) make a strong case for changing that status quo. They have found that 30 minutes or less of question-and-answer about the family history of depression, anxiety, or substance abuse is enough to predict a patient’s approximate risks for developing each disorder and how severe their future illness is likely to be.

“There are lots of kids with behavior problems who may outgrow them on their own without medication, versus the minority with mental illnesses that need treatment,” said Terrie Moffitt, a professor of psychology and neuroscience in the IGSP. “Family history is the quickest and cheapest way to sort that out.”

Researchers who are on the hunt for genes responsible for mental disorders might also take advantage of the discovery, added Avshalom Caspi, an IGSP investigator and professor of psychology and neuroscience. “It suggests they may be better off selecting people with more serious illness or, better still, collecting family history information directly,” he said.

That mental illnesses tend to run in families is certainly no surprise. In fact, psychiatric conditions are some of the most heritable of all disorders. But the link between family history and the seriousness of psychiatric disease has been less certain.

Moffitt, Caspi and their colleagues looked to 981 New Zealanders born at a single hospital in 1972 or 1973, who are participants in what is known as the Dunedin Study. Researchers have been tracking the physical and mental health and lifestyles of those enrolled in the longitudinal study since they were 3 years old.

In this case, Caspi and Moffitt’s team tested each individual’s personal experience with depression, anxiety, alcohol dependence and drug dependence in relation to their family history “scores” – the proportion of their grandparents, parents and siblings over age 10 who were affected. The analysis shows that family history can predict a more recurrent course of each of the four disorders. It is also indicative of those more likely to suffer a worse impairment and to make greater use of mental health services. Contrary to earlier reports, those with a stronger family history did not necessarily develop their disorders at an earlier age.

Family history could be used to identify those in need of early intervention or more aggressive treatment, the researchers said. But if a few, simple questions could have that much value, why has family history been ignored for so long?

Moffitt said that health professionals have shied away from questioning people about their family history of mental illnesses because of the stigma attached to them. “There’s a sense that families are not as open about mental disorders — that people may not know or may make incorrect assumptions,” she said.

The new findings suggest those concerns may be overblown. One key, they say, is in how you go about asking the questions.

For example, instead of asking each person if any of their relatives had a history of anxiety disorder outright, the researchers asked, “Has anyone on the list of family members ever had a sudden spell or attack in which they felt panicked?” If the interviewee came up with a name, they were then asked, “Did this person have several attacks of extreme fear or panic, even though there was nothing to be afraid of?”

There is another very practical reason that those in the mental health profession don’t ask about family history. The “bible of psychiatry,” officially known as The Diagnostic and Statistical Manual of Mental Disorders (DSM), makes no mention of it. The DSM is the primary tool for making mental health diagnoses and delivering mental healthcare in the U.S. and, to some extent, in other countries around the world.

“There’s nothing about family history in the DSM even though it may be the most important,” Moffitt said. There will soon be an opening to fix that. Experts including Moffitt are now in the process of revising the DSM, which is currently in its fourth edition. The next edition, DSM-V, is due for publication in 2012.

Coauthors on the study include HonaLee Harrington of Duke; Barry Milne of the University of Auckland; Michael Rutter of King’s College London; and Richie Poulton of the University of Otago. The original report appears in the July 2009 issue of Archives of General Psychiatry.

Source:
Kendall Morgan

Duke University

Industry’s youngest legal targets now 18- to 24-year olds –

A widespread tobacco industry marketing strategy – sponsoring social events and giving out free cigarettes at bars, clubs,
and college parties – is reaching students and may be encouraging them to take up smoking, according to a new study released
today. The study, part of the Harvard School of Public Health (HSPH) College Alcohol Study (CAS), appears in the January
issue of the American Journal of Public Health. The study was led by Nancy Rigotti, MD, director of the Tobacco Research and
Treatment Center of Massachusetts General Hospital (MGH).

According to the study, students at all but one of the 119 U.S. colleges and universities surveyed reported attending a
tobacco-industry-sponsored social event on or off campus in 2001. Although the number of students reached at many schools was
relatively small, up to 27 percent of students were reached at some schools. Overall, 8.5 percent of students had attended a
tobacco-industry-sponsored social event where free cigarettes were distributed. Bars and nightclubs were the most common
settings, but students also reported attending events on college campuses, a site that has received less attention and
provides direct access to students.

Those who had attended these tobacco promotions were more likely to be current smokers, compared to students who had not
attended an event. Perhaps most notably, the study suggested that these events could be a powerful inducement to begin
smoking. Students who had not started to smoke by the age of 19 were especially likely to have become smokers by the time of
the survey if they had been exposed to a tobacco promotion at a bar, nightclub, or college social event.

This is the first study that has measured young adults’ exposure to a tobacco industry marketing strategy that has assumed
greater prominence since the 1998 Master Settlement Agreement, in which the tobacco industry agreed not to market to
teenagers, making young adults (aged 18 to 24) its youngest legal targets. “By distributing cigarettes and sponsoring these
events in bars and on college campuses, the tobacco industry promotes the idea that cigarettes are an essential part of young
adults’ social lives,” said Rigotti.

The study analyzed data from the 2001 HSPH CAS, a random sample of 10,904 students enrolled in 119 nationally representative
4-year U.S. colleges and universities. The study authors were Rigotti, Susan Moran, MD, also of the MGH Tobacco Research and
Treatment Center; and Henry Wechsler, PhD, director of the HSPH College Alcohol Study.

Bars and nightclubs have assumed greater importance for tobacco marketing since the Master Settlement Agreement, which limits
the distribution of free cigarette samples to facilities that do not admit minors. Bars and nightclubs also are
smoker-friendly environments for the tobacco industry, because they are among the few places where smoking is not generally
restricted by clean-air laws.

In the study, students who reported attending these events were more likely to be current cigarette smokers (defined as
having smoked a cigarette in the past 30 days) than students who had not attended one of these events. Even after statistical
adjustments for a broad range of factors that might have explained the relationship, a strong association remained between
attending tobacco-industry-sponsored events and current smoking, with those attending such events 75 percent more likely to
be current smokers.

Furthermore, the analysis suggested that the effect of bar promotions on smoking behavior was strongest on students who had
entered college as nonsmokers. Of the 8,482 students (78 percent) who did not smoke regularly before age 19, the current
smoking prevalence rate was 23.7 percent among those who had attended a promotional event compared with 11.8 percent among
those who had not. In contrast, in the 2,334 students who smoked regularly before age 19, there was no significant difference
in current smoking prevalence between those who had and had not attended a tobacco promotional event.

“These findings should serve as a wake-up call to college and university administrators,” said Wechsler. “The evidence that
these events may influence a non-smoking young person’s decision to start smoking is a good reason they should be alert to
tobacco industry sponsorship of these events and take appropriate action on their campuses.” The American College Health
Association recommends that colleges ban the free distribution of tobacco products on campus, including at fraternities and
sororities, and prohibit tobacco industry sponsorship of social events held by any organization that receives college funds.

“These findings also give states and communities another good reason to adopt smoking bans in bars and nightclubs,” says
Rigotti. “Tobacco-free bars and nightclubs are likely to be less attractive as sites for tobacco industry promotions.
Decoupling smoking and drinking will likely be an effective way to counteract the tobacco industry’s marketing strategies.”

The study was funded by the Robert Wood Johnson Foundation, the Flight Attendant Medical Research Institute, and the National
Heart Lung and Blood Institute

The full study and additional information on the Harvard School of Public Health College Alcohol Study will be available
after December 28 at: hsph.harvard/cas.

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The governments ‘new’ drug strategy has caused a mixed reaction. Some mild some vehement; others have reacted with cautious enthusiasm, and a few with cynicism.

The majority who have commented have their own agenda’s. The pro-druggists are professing that the ‘rights’ of users are being ignored and that drug related crime will soar. The ‘hang em’ and ‘flog em’ brigade will be disappointed that there is no provision for users to be taken out and shot at dawn.

This writer is appalled and baffled for the simple reason that in all sixty eight pages of the strategy there is no acknowledgement that both substance misuse and dependency are universally recognised as mental disorders. (1&2)

The inexplicable failure to acknowledge that fact is compounded by the lack of recommendations for treating it as such. There are a few references to users who have mental disorders which appear to be seeking to separate the two. Such a fundamental error, combined with the error of failing to acknowledge misuse and dependency as a mental disorder in its own right, together with failing to acknowledge that co-occurring mental disorders are common with substance misuse and dependency, thus producing the condition of comorbidity, results in the further failure of recognising that such conditions requires integrated treatment if recovery is to be achieved.

It has been clearly established that comorbidity of mental disorders and substance use disorders is widespread and often associated with poor treatment outcome, severe illness and high service use. (3) This presents a significant challenge with respect to the most appropriate identification, prevention and management strategies

In failing to meet that challenge, and subsequently failing to produce relevant strategies, the UK strategy, hailed by Downing Street as a ‘comprehensive approach’ is anything but comprehensive, it is therefore unlikely to be any more effective in its aims than its predecessor, although in fairness it would struggle to be worse.

There is a universal rule which indicates that fundamental errors lead to others, this latest offering from Whitehall is no exception. Indeed the errors and glaring omissions mentioned, have led to misleading statements, not the least of which are assertions claiming success of the previous strategy in a number of areas where it has failed miserably in achieving its declared objectives.(4)

One claim that is grossly misleading appears on page 6 of the new strategy:

“..use all emerging and all available evidence to make sure we are supporting the treatment that is most effective, targeted on the right users – with abstinence-based treatment for some, drug-replacement over time for others, and innovative treatments including injectable heroin and methadone where they have been proved to work and reduce crime”.

Insofar as heroine treatment is concerned there is empirical evidence that it neither works nor reduces crime. The Cochrane review of worldwide trails came to the following conclusion “No definitive conclusions about the overall effectiveness of heroin prescription is possible”. (5) There is the further failure to acknowledge that dependency, which in this case is more accurately described as addiction, is an irreversible condition, and that without abstinence the severity of the addiction will increase, that so call innovative heroin treatments simply serve to keep the dependent user locked into addiction.(6) Even more serious is the fact that it also increases the severity of addiction to the point where the free will of the addicted is eroded.(7)

Methadone treatment does not fare much better, however it has to be acknowledged that it does keep people in treatment longer and reduces heroin use. Notwithstanding that it is a highly addictive drug in its own right and it is generally conceded that the majority of those on such treatment continue to misuse other drugs, therefore it can be argued that it also keeps users locked into addiction.

So rather than using all the ‘available evidence’ as this so called strategy would have us believe, it is ignoring evidence from World Wide Authorities. Readers will form their own conclusions as to whether this document is flawed and, or misleading. In either event such wilful ignoring of evidence destroys much of its credibility.

If the disregard for evidence, and the inaccurate claims made, grave as they are, were an isolated incident in the ‘new strategy’ this writer might be regarded by some as being churlish, regrettably this is not the case. Much is made in the document of how the strategy will bring about ‘social re-integration’. In doing so it claims that that the new strategy will help “drug misusers to overcome dependence and re-establish their lives”.

How can a strategy which fails to recognise substance misuse and dependency for what it is, a mental disorder, which is both chronic and complex in nature, possibly hope to re-integrate into society those, which the state has not only failed to treat in accordance with universal evidence, but proposes treatment that will increase the severity of the condition?

References:

1 – International Classification of Mental and Behaviour Disorders: ICD-10: World Health Organisation: Geneva 1993.

2 – Diagnostic and Statistical Manual of Mental Disorders: DSM -1V:.American Psychiatric Association : 1994

3 – Maree Teesson and Lucy Burns: National Drug and Alcohol Research Centre: Publications Production Unit (Public Affairs, Parliamentary and Access Branch) Commonwealth Department of Health and Aged Care. Canberra

4 – The Disastrous Outcome Of The UK Drug And Treatment Strategy Article: 02 Jan 2008.medicalnewstoday

5 – Ferri M, Davoli M, Perucci CA. Heroin maintenance for chronic heroin dependents. Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD003410 DOI10.1002/14651858.CD003410.pub2.

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6 – Eric A Voth, chairman Internal Medicine and Addiction Medicine, Institute FL 33701, USA EVothstormontvail Ernst Aeschbach, doctor Private Practice of Psychiatry, Bettackerstrasse 7, CH-8152 Glattbrugg, Switzerland: BMJ 2004;328:229 (24 January), doi:10.1136/bmj.328.7433.229.

7 – NIDA Director Nora Volkow, M.D., Psychiatric News July 6, 2007
Volume 42, Number 13, page 16© 2007 American Psychiatric Association

© Peter O’Loughlin
The Eden Lodge Practice, BR3 3AT UK. February 2008.