The projected four-year study will focus on the higher rates of oral diseases among methamphetamine users and how the presence of serious dental diseases in patients can help identify methamphetamine users in the early stages of abuse since other medical symptoms are usually not manifest in the outset of abuse.

The study will be led by Dr. Vivek Shetty, professor of oral and maxillofacial surgery at UCLA’s School of Dentistry. Dr. Shetty co-authored a new report in the Journal of the American Dental Association on recognizing how severe oral disease plays a prevalent role in diagnosing methamphetamine abuse along with the other comorbid physical and physiological adverse reactions that are caused by this addiction. Dr. Shetty emphasized the unique ability of dental professionals to participate in the intervention process of drug abuse management upon discovering signs of methamphetamine use in their patients to help offer these individuals the medical assistance and support they badly require.

The NIDA-funded study is also aimed at defining the burden to oral health and hygiene that methamphetamine use causes, and to characterize how this problem has grown into a public health epidemic. NIDA estimated that there were 850,000 Americans ages 12 and older in 2008 who had abused methamphetamine that year, and that 10 million Americans have abused methamphetamine during their lifetime. The RAND Corporation estimates that methamphetamine abuse had cost the nation $23.4 billion in 2005, including costs for criminal justice, law enforcement, medical and emergency resources, premature deaths, loss of productivity, foster care, illicit production resulting in domestic disaster (i.e., home-made meth lab explosions), and treatment resources.

Aside from the severe dental problems caused by methamphetamine use (known as "meth mouth”), methamphetamine abusers can experience a range of physical symptoms including increased alertness, wakefulness, sleep deprivation, increased blood pressure, increased respiration, rapid heart rate, hyperthermia, and decreased appetite. More serious long-term effects include anxiety, uncharacteristic moods, anger, aggressiveness, confusion, memory loss, extreme weight loss, paranoia, hallucinations, delusions, and irreversible brain damage. Methamphetamine abusers also have a higher risk of obtaining HIV/AIDS and other infectious diseases.

Methamphetamine addiction causes hundreds of premature deaths in the U.S. each year. With the integration of this new research funded by NIDA, even medical practitioners in the dental profession can join the forefront on drug abuse prevention and intervention.

At the conference titled “Blending Addiction Science and Practice: Evidence-Based Treatment and Prevention in Diverse Populations and Settings,” NIDA Director Dr. Nora Volkow discussed the many factors that make substance abuse addiction a multifaceted disease. Substance abusers are affected by their environments, genetics, psychology, biology, and emotions. As an addiction progresses, the abuser experiences negative changes to their body on a neurobiological level, causing multiple repercussions in their personal health, behavior, and development.

Traditional treatment for addiction includes cognitive-behavioral therapy and rehabilitation that may include pharmaceutical intervention. With the integration of these novel drug addiction vaccines, recovery patients may become more adhesive to treatment programs and more capable of completing recovery and remaining abstinent. The new vaccines are designed to help suppress cravings and prevent the addictive molecules in illicit substances from reaching the brain, which causes dependency. As many recovering addicts often experience relapse after treatment, these new vaccines will effectively lower the risk of setback and help change recovery treatment strategies. Recovery treatment periods are extended to incorporate this vaccination stage that helps meet the need of relapse prevention. The goal of the conference was to incorporate new clinical research into standard addiction medicine practice.

If the immune system can be strengthened to withstand the presence of such addictive substances as nicotine or cocaine, can addiction be defeated? Clinical trials with the new vaccine called NicVax from Nabi Biopharmaceuticals have shown signs of this possibility. NicVax stimulates the immune system to produce antibodies in response to nicotine, which bond to the nicotine molecules in the system and prevent them from entering the brain where they generate psychoactive effects. Without this ‘high’ that changes the brain’s neurotransmitters and makes normal brain function dependent on the presence of nicotine, tobacco use may become less addictive, and quitters may actually stay abstinent.

In NIDA’s human trials, more than 30% of NicVax participants were able to successfully overcome their addictions and remain abstinent after having developed antibodies. According to NIDA, approximately 71 million Americans over the age of 12 are current tobacco users. About 440,000 tobacco-related deaths occur each year, or approximately one in five American deaths. NIDA has also found that 35 million smokers are aware of the dangers of smoking and wish to quit, but 85% of those who attempt cessation will relapse. Of the latest vaccines, NicVax will most likely be the first one available for prescription. NicVax may also become an ideal component of recovery therapy since it does not produce any adverse effects. It may take a few more years before NicVax gains FDA approval if it increasingly demonstrates positive results.

NIDA also revealed its new treatment program for adolescents suffering from opioid addiction: Buprenorphine Treatment for Young Adults. Buprenorphine, an anti-addiction medication, is already used in addiction treatment for adults addicted to heroin and other opioids, but NIDA research conducted in conjunction with the Substance Abuse and Mental Health Services Administration (SAMHSA) has shown that buprenorphine can be just as effective for adolescents. The program involves an extended treatment period for young adult patients which includes long-term use of buprenorphine medication, as opposed to the typical shorter detoxification period followed by post-treatment medication. Buprenorphine not only helps control opioid addiction by suppressing cravings, but it may also help younger patients adhere to treatment, complete recovery, and achieve long-term goals. NIDA is offering a three-hour training program for clinicians and addiction medicine specialists that explains how buprenorphine works in adolescent patients, how to select appropriate patients from this vulnerable group for buprenorphine treatment, and the legalities surrounding the use of the new medication.

Often, those with substance abuse addictions also experience comorbid disorders. Further research from NIDA has been focusing on how to best integrate effective treatment techniques into such vulnerable groups as American Indian and other native populations who experience high levels of substance abuse and HIV infection. NIDA hopes that an interwoven treatment model that includes indigenous and Western strategies for trauma and substance abuse recovery will generate positive results in recovery and prevention efforts. Also, NIDA discussed strategies for creating more effectual counseling and medical treatment for military personnel suffering from substance abuse disorders, post-traumatic stress disorder (PTSD), and other psychological and social disorders.

Reuters reports that researchers at the University of Maryland, who asked 200 students to give up all media for one full day, found that after 24 hours many showed signs of withdrawal, craving, and anxiety, along with an inability to function well without their media and social links.

Susan Moeller, the study’s project director and a journalism professor at the university, said many students wrote about how they hated losing their media connections, which some equated to going without friends and family.

"I clearly am addicted and the dependency is sickening," said one student. "Between having a Blackberry, a laptop, a television, and an iPod, people have become unable to shed their media skin."

Moeller said students complained most about their need to use text messages, instant messages, e-mail, and Facebook.

"Texting and IM-ing my friends gives me a constant feeling of comfort," wrote one of the students, who blogged about their reactions. "When I did not have those two luxuries, I felt quite alone and secluded from my life."

Few students reported watching TV news or reading a newspaper.

The American Psychiatric Association does not recognize so-called Internet addiction as a disorder. But it seems to be an affliction of modern life. In one extreme example in South Korea reported by the media, a couple allegedly neglected their three-month-old daughter, who died of malnutrition, because they were on the computer for up to 12 hours a day raising a virtual child.

Last year a small private center called ReSTART, located near Redmond, Washington, opened to treat excessive use of the Internet, video gaming, and texting. The center’s website cites various examples of students who ran up large debts or dropped out of college due to their obsession.

Students in the Maryland study also showed no loyalty to news programs, a news personality, or news platform. They maintained a casual relationship to news brands, and rarely distinguished between news and general information.

"They care about what is going on among their friends and families and even in the world at large," said Ph.D. student Raymond McCaffrey who worked on the study. Loyalty "does not seemed tied to any single device or application or news outlet."

Science Daily reports that this population-based research is the first to examine the association of childhood ETS with early emphysema by CT scan in nonsmokers. Approximately half of the participants in this large multiethnic cohort had at least one regular cigarette smoker in their childhood home. Participants with more childhood ETS exposure had more emphysema-like lung pixels; an average of 20% of scan pixels were emphysema-like for those who lived with two or more smokers as a child, compared with 18% for those who lived with one regular smoker, or 17% for those who said that they did not live with a regular inside smoker as a child.

The researchers studied CT scans of 1,781 non-smokers without clinical cardiovascular disease recruited from six communities in the United States, including northern Manhattan and the Bronx, New York. Those reporting childhood ETS exposure were somewhat younger with an average age of 61, were more likely to be non- Hispanic white, and were less likely to have been born outside the United States. These differences were statistically controlled in the analyses.

"We were able to detect a difference on CT scans between the lungs of participants who lived with a smoker as a child and those who did not," observed Gina Lovasi, PhD, MPH, assistant professor of epidemiology at Columbia’s Mailman School of Public Health. "Some known harmful effects of tobacco smoke are short term, and this new research suggests that effects of tobacco smoke on the lungs may also persist for decades."

Previous studies have found evidence that childhood ETS exposure affects perinatal and childhood health outcomes, and that adult exposure may affect adult respiratory health outcomes, including lung function and respiratory symptoms.

Although childhood ETS was not associated with adult lung function in this healthy population, this does not contradict the results for early emphysema, since airflow obstruction and anatomic damage are theoretically and clinically distinguishable. "However, emphysema may be a more sensitive measure of damage compared with lung function in this relatively healthy cohort," Dr. Lovasi notes.

Combined emphysema and chronic obstructive pulmonary disease are projected to become the third leading cause of death worldwide by 2020.

The exposure information in this study does not provide information on the timing of ETS exposure during childhood, making it difficult to distinguish as exposure in utero. "The association between childhood ETS and early emphysema among participants whose mothers did not smoke, suggests that the effect we are detecting is for smoke exposure in the home during childhood rather than in utero exposure alone," observed Dr. Lovasi.

This work was supported by the National Institutes of Health and the Robert Wood Johnson Foundation Health & Society Scholars Program and the National Institutes of Health.

To better understand drinking trajectories from drinking onset to midlife, the Journal of Studies on Alcohol and Drugs recently released a study: Drinking Trajectories from Adolescence to the Fifties Among Alcohol-Dependent Men wherein 420 men were evaluated due to their lifetime diagnosis of alcohol dependence.

The Lifetime Drinking History was given to men who were from the Vietnam Era Twin Registry to assess the pattern of alcohol consumption and diagnostic symptoms for self-defined drinking phases. The data captured from different phases was converted into person-year data. In these phases, alcohol-dependence diagnosis was coded as present or absent for each of 13 age groupings.

Researchers relied on latent growth mixture modeling to define four drinking trajectories, including young-adult, late-onset, severe-non-chronic, and severe-chronic alcoholics. Additional analysis was completed on these men to capture drinking variables, alcohol expectancies, personality scales and religiousness scores in an effort to differentiate the men by each trajectory.

In the course of this data capture and analysis, researchers used the Extension of Latent Growth Mixture Modeling (LGMM) into the mid-50s to determine that while some individuals continue to be chronic alcohol users into this age range, there are still others who will decline in alcohol problem use.

Such an approach to studying trajectories is important as it can help in the development of proper treatment of alcohol dependence that is customized according to specific characteristics. For those who are likely to be in the more severe trajectories, physicians can more easily apply more intense treatments.

While the information provided in these studies is vital for the continued investigation into the overall impact alcohol has on an individual over time, trajectories is still an area lacking in proper research and other resources. Continued focus should be given to this area, expanding it to female drinkers to assess their risk and how it may differ from that of males.

Overall, this area of study will be important to continue over time as treatments are changing according to specific needs. The more successful these treatments are when based on intensity of trajectory, physicians and treatment specialists are more inclined to alter their approach to alcohol dependence recovery and care.
 

Science Daily recently posted a release that summarized the activities of Dr. Jon Grant and his team of researchers at the University of Minnesota. This team used tasks to measure cognition to identify what motivates such extreme gambling behaviors.

One truth identified in this process is that people with a pathological gambling disorder will continue their behavior even when faced with damaging consequences to themselves and to their families.

In focusing on urge and inhibition, researchers studied pathological gamblers by separating them into two groups: those driven by urge and those who do not display normal inhibition of impulse behaviors. The first group responded well to treatment with medications that block the brain opioid system. The second group responded well to medications that act on a specific enzyme.

“By understanding these different subtypes, we are able to target the core biology of the illness with individualized treatment,” said Jon Grant, MD, JD, MPH, Associate Professor of Psychiatry at the University of Minnesota and ACNP member. “When we look at pathological gambling as an addiction and try to understand the sense of urges and inhibitions, we are able to target the treatment with medication more effectively.”

Pathological gambling affects roughly two percent of the population. While the results of this study are exciting for those who truly want to change, there are still some who are unable to respond to medication therapy. Additional research is needed to identify the best treatments and understand how to progress forward.

A longitudinal study showed that only 15 percent of those committed to never smoking at the start of the study experimented with cigarettes over three years of follow-up. At the same time, 45 percent of those who were deemed to be susceptible at first went on to experiment.

“Susceptibility to smoking is a measurable characteristic that predicts transition to smoking. Our results suggest that prevention efforts tailored to an adolescent’s susceptibility status may be more effective among Mexican-American youth,” said senior author Anna Wilkinson, Ph.D., assistan

t professor in M. D. Anderson’s Department of Epidemiology.

The authors of this study note that Mexican-American adolescents are more inclined to experiment than other groups. This experimentation is likely to lead to a permanent habit. As a result, it is important to offer an opportunity for early intervention.

Researchers followed 964 Mexican-origin girls and boys ages 11 to 13 from the Houston metro area. The study identified significant predictors of experimentation, which included being male, 13 years old, having low subjective social status, having some positive expectations about smoking, at least one detention and living with someone who smokes.

The authors argue that the results of this study suggest that being susceptible to smoking is not ethnic-specific. Future studies are needed to understand and target risk factors for susceptibility to prevent experimentation. It is also important to understand if the same factors involved in smoking and experimentation lead to drug or alcohol use.

Grunberg describes the study, published by Natividad et al. in Synapse journal, as "fascinating" and suggests that it "may have implications to help understand why adolescents are particularly prone to drug abuse."

Nicotine increases the level of dopamine in the brain, a neurotransmitter that is responsible for feelings of pleasure and wellbeing. The study looked at dopamine levels in adolescent and adult rats after nicotine withdrawal. The authors found that the withdrawal signs (physical and neurochemical) seen in adolescent rats were fewer than those observed in adults.

The study provides previously unknown mechanisms as to why there are differences in nicotine withdrawal between adolescent and adult rats. The key here, as stated by Grunberg, is that "age alters [neurological] systems and interactions relevant to nicotine."

The reason that adolescents are prone to drug abuse (in this case, nicotine) is that they have increased sensitivity to its rewarding effects and do not display the same negative withdrawal effects as adults do, due to an underdeveloped dopamine-producing system.

Since rats are not subject to cultural influences, "rat studies of nicotine…have provided valuable insights that have led to practical behavioral and pharmacological interventions," says Grunberg.

The results of this study may not stop at nicotine. Grunberg continues, "These findings might also be relevant to other addictive and abuse drugs."

"We were able to show that children who are exposed to tobacco smoke prenatally and during the first years of life have a higher risk of developing abnormal behavioral symptoms when they are of school age," said Dr. Joachim Heinrich of the Institute of Epidemiology at Helmholtz Zentrum München. "Moreover, it makes a difference whether the child was exposed to tobacco smoke first after birth or was already confronted with it during prenatal development."

According to the study, children who were only exposed to tobacco smoke prenatally have a 1.9 times higher risk of developing abnormal behavioral symptoms in comparison to children without any exposure (change this if it is the wrong comparison). The risk for children first exposed to tobacco smoke after birth is 1.3 times higher. Furthermore, children who were exposed to tobacco smoke both while in the womb and while growing up doubled the risk of developing abnormal behavioral symptoms. Such symptoms include hyperactivity, attention deficits or problems in their relationships with peers. The results of the study were independent of affects from the social environment in which the children were growing up.

In the framework of the GINI-plus study, data of a large birth cohort comprising 5,991 children and their parents was analyzed. Extensive studies will follow up on this study.

"The value of our study is based not only on our prospective, investigative approach, but also on the comprehensiveness of our survey as to possible pollution levels for the unborn, infants and children at different times," Joachim Heinrich explained. "This makes it possible to determine the effects of prenatal and postnatal tobacco smoke exposure and to differentiate between them."

To ensure the validity of their results from the questionnaires, the scientists carried out carefully controlled tests to exclude possible bias due to social factors. Simon Rückinger, lead author of the study, stated: "The relationship we found between tobacco exposure during fetal development and early childhood and behavioral problems at school age was not biased by other factors of the social environment."

The findings make clear that tobacco smoke exposure has a significant impact on the behavioral development of children. The negative influence is greater on the unborn child during the pregnancy of the mother than it is after this sensitive developmental phase.

"We found that exposure to cigarette smoke appears to increase the thickness of the epithelium, or lining, of the airways in the lung. This may be the underlying cause of the fact that smoking asthma patients experience more asthma symptoms, such as shortness of breath and phlegm production, compared to non-smoking asthma patients," said Martine Broekema, Ph.D., the lead author of the study.

Science Daily reports that Dr. Broekema and colleagues examined patients with asthma who were assessed for the severity of their asthma and allergy, given questionnaires to determine the extent of their smoke-induced symptoms, and then underwent bronchial biopsies. Of 147 patients, 66 never smoked, 46 were ex-smokers, and 35 were current smokers.

In addition to the changes in the epithelial thickness, Dr. Broekema found distinct differences between the current smokers and the ex- and non-smokers. "In addition to the epithelial thickening, we found that cigarette smoke negatively affects levels of exhaled nitric oxide, making it an unreliable indicator of asthma severity in smokers," she said.

Current smokers also had more mucous-producing goblet cells in their epithelium and the epithelial cell layer contained more mucus protein overall, when compared to never-smoking asthmatics.

"These pathological findings were associated with the severity of phlegm production reported by the asthma patients, suggesting a causal relationship between the two. Smoking asthmatics also showed a distinct inflammatory profile in their lungs compared to never-smoking asthmatics, with a lower number of eosinophils and higher number of mast cells," said Dr. Broekema. "Furthermore, our data suggest that smoking cessation can reverse the thickening of the lining of the airways."

To determine the role of exposure length on asthmatic lungs, the scientists divided the ex-smokers into two groups: those with fewer than the median 3.4 pack-year exposure and those with more than 3.4 pack-years.

Interestingly, while they expected to find evidence of a dose-response effect between smoking and epithelial remodeling, no such association was apparent between the number of pack-years or duration of smoking cessation and epithelial remodeling.

"To our surprise, these two sub-groups of ex-smokers showed no difference in any outcome measure. These sub-analyses indicate that the amount of smoke exposure in the past does not influence our outcome measures," said Dr. Broekema.

"This study shows again how important smoking cessation is for pulmonary health, and this appears to be especially true for asthmatic patients. The good news is that quitting appears to have a measurable benefit in these individuals."