People who drink light to moderate amounts of alcohol in later life are less likely to develop dementia than people who abstain from alcohol consumption, a study from The Australian National University has found.
The meta-analysis analysed the outcomes of 15 research studies meeting rigorous scientific criteria exploring links between drinking and dementia, drawing on the results for more than 10,000 people worldwide.
"We looked at the results of studies that followed up with participants at intervals over two to eight years," said study leader Prof Kaarin Anstey from the Centre for Mental Health Research (CMHR) at ANU. "We then used statistical analysis to synthesise the results and to weight the studies according to their sample size.
"We found that light to moderate drinkers were 28 per cent less likely to develop Alzheimer's than non-drinkers, 25 per cent less likely to develop vascular dementia, and 26 per cent less likely to develop 'any dementia'."
Dr Anstey said that some of the research projects considered in the ANU synthesis study only reported whether participants were 'drinkers' or 'non-drinkers' without exploring the extent of people's drinking. In these studies drinkers had 44 per cent reduced risk of developing Alzheimer's and 47 per cent reduced risk of developing 'any dementia'.
The meta-analysis also found that the relationship between drinking and dementia was the same for men and women, with light to moderate drinkers showing decreased incidence of dementia regardless of sex.
"It should be noted that the studies we found on this topic nearly all focussed on older adults and their drinking habits," Prof Anstey said. "There is not yet enough scientific data published to draw conclusions about how early life alcohol consumption affects later dementia risk. We also did not analyse the type of alcohol beverages consumed as there are not enough studies that reported results separately for beer, wine etc."
Prof Anstey, who heads the Ageing Research Unit at the CMHR, said that it wasn't clear why light to moderate drinkers were less likely to develop dementia, but suggested that it could be to do with a protective effect of alcohol in reducing inflammation and heart disease, the benefits of social interactions associated with alcohol consumption, or Characteristics of individuals recruited into the studies.
The report is published in the American Journal of Geriatric Psychiatry and the research was also supported by the ANU Dementia Collaborative Research Centre.
Source
The Australian National University
пятница, 27 мая 2011 г.
четверг, 26 мая 2011 г.
New Cigarette Smoking Strategy Reduces Nicotine Addiction
Scientists are reporting the first successful strategy to reduce smokers' nicotine dependence while allowing them to continue smoking. The study provides strong support for proposals now being considered in Congress to authorize FDA regulation of cigarette smoking, according to the research team.
The key to the clinical trial's success was providing smokers with cigarettes of gradually decreasing nicotine content over a number of weeks. If such cigarettes were federally mandated, smokers would find it easier to quit, and more young smokers could avoid addiction, according to the scientists. Tobacco company products marketed as low-nicotine alternatives, in fact, do not change the level of nicotine taken in by smokers, they added.
The research was carried out by scientists at UCSF and San Francisco General Hospital Medical Center and is reported in the November 14 issue of the journal Cancer Epidemiology, Biomarkers & Prevention.
Legislation giving the FDA authority to regulate tobacco products is currently being considered in Congress. Such regulatory authority would empower the agency to develop and enforce standards to make cigarettes less harmful -- including the reduction of the nicotine yields so that cigarettes would be less addictive, said Neal Benowitz, MD, leader of the study team and an expert on the pharmacology and health effects of nicotine and other smoking products.
Smoking and health experts have been concerned that reducing the nicotine content of cigarettes would lead to smoking a greater number of cigarettes and therefore increased exposure to other tobacco smoke toxins, as is seen in smokers of the currently marketed low-nicotine yield cigarettes, Benowitz said. The new research on reduced-nicotine content cigarettes strongly counters that prediction.
In the study, 20 healthy adult smokers smoked their usual brand for a week and then followed a six-week regimen of smoking cigarettes with progressively decreased nicotine content.
At the end of this period, they were free to return to their usual commercial cigarette brand, and most of them did. When tested one month later, they were smoking about 40 percent fewer cigarettes per day, with a comparable reduction in nicotine intake, compared to when the study began. Even more promising, one fourth of the smokers quit smoking entirely while the study was in progress, the researchers found.
"This study supports the idea that if tobacco companies were required to reduce the levels of nicotine in cigarette tobacco, young people who start smoking could avoid becoming addicted, and long-time smokers could reduce or end their smoking, Benowitz said.
"This could spare millions of people from the severe health effects of long-term smoking," he added.
Benowitz is a UCSF professor of medicine, psychiatry and biopharmaceutical sciences, and chief, Division of Clinical Pharmacology and Experimental Therapeutics at SFGH.
In 1994, Benowitz and colleague Jack Henningfield proposed in the "New England Journal of Medicine" that federal regulations should require cigarette manufacturers to gradually reduce nicotine content of all cigarettes sold in the U.S.
Scientists have conducted studies to test nicotine-reduction strategies, using commercial low-yield cigarettes. Such cigarettes do reduce nicotine yield when tested by smoking machines because manufacturers have engineered the cigarettes to burn faster, and they have used highly porous paper and ventilation holes above the filter. These cigarettes contain significant levels of nicotine and such "cigarette engineering" does not lead to decreased nicotine intake, because smokers are easily able to obtain the nicotine by taking more frequent and bigger puffs, Benowitz and his co-authors noted.
In contrast, in the new study, the absolute content of nicotine in the tobacco was reduced so that it was very difficult or impossible to compensate by smoking more intensely.
In addition to the reduced smoking and nicotine levels, the UCSF scientists looked for changes in exposure to carbon monoxide, tobacco smoke carcinogens and cardiovascular disease risk factors. All these remained stable or decreased, indicating that smokers were not exposed to higher levels of tobacco smoke toxins when they switched, and therefore would not be put at risk by a nicotine reduction intervention.
Benowitz and his colleagues are now conducting a much larger and longer clinical study on the effectiveness and safety of reducing nicotine levels in cigarettes. They plan also to examine whether reduced-nicotine cigarettes result in reduced addiction potential among adolescent experimental smokers.
The study was funded by the National Cancer Institute, National Institute on Drug Abuse, California Tobacco Research Program, and Division of Research Resources, National Institutes of Health.
Collaborators with Benowitz on the study and co-authors on the paper are UCSF researchers Sharon M. Hall, PhD; Susan Stewart, PhD; Margaret Wilson, MS; Delia Dempsey, MD, and Peyton Jacob III, PhD. Benowitz, Wilson, Dempsey and Jacobs are based at SFGH.
UCSF is a leading university dedicated to defining health worldwide through advanced biomedical research, graduate level education in the life sciences and health professions, and excellence in patient care.
Source: Wallace Ravven
University of California - San Francisco
The key to the clinical trial's success was providing smokers with cigarettes of gradually decreasing nicotine content over a number of weeks. If such cigarettes were federally mandated, smokers would find it easier to quit, and more young smokers could avoid addiction, according to the scientists. Tobacco company products marketed as low-nicotine alternatives, in fact, do not change the level of nicotine taken in by smokers, they added.
The research was carried out by scientists at UCSF and San Francisco General Hospital Medical Center and is reported in the November 14 issue of the journal Cancer Epidemiology, Biomarkers & Prevention.
Legislation giving the FDA authority to regulate tobacco products is currently being considered in Congress. Such regulatory authority would empower the agency to develop and enforce standards to make cigarettes less harmful -- including the reduction of the nicotine yields so that cigarettes would be less addictive, said Neal Benowitz, MD, leader of the study team and an expert on the pharmacology and health effects of nicotine and other smoking products.
Smoking and health experts have been concerned that reducing the nicotine content of cigarettes would lead to smoking a greater number of cigarettes and therefore increased exposure to other tobacco smoke toxins, as is seen in smokers of the currently marketed low-nicotine yield cigarettes, Benowitz said. The new research on reduced-nicotine content cigarettes strongly counters that prediction.
In the study, 20 healthy adult smokers smoked their usual brand for a week and then followed a six-week regimen of smoking cigarettes with progressively decreased nicotine content.
At the end of this period, they were free to return to their usual commercial cigarette brand, and most of them did. When tested one month later, they were smoking about 40 percent fewer cigarettes per day, with a comparable reduction in nicotine intake, compared to when the study began. Even more promising, one fourth of the smokers quit smoking entirely while the study was in progress, the researchers found.
"This study supports the idea that if tobacco companies were required to reduce the levels of nicotine in cigarette tobacco, young people who start smoking could avoid becoming addicted, and long-time smokers could reduce or end their smoking, Benowitz said.
"This could spare millions of people from the severe health effects of long-term smoking," he added.
Benowitz is a UCSF professor of medicine, psychiatry and biopharmaceutical sciences, and chief, Division of Clinical Pharmacology and Experimental Therapeutics at SFGH.
In 1994, Benowitz and colleague Jack Henningfield proposed in the "New England Journal of Medicine" that federal regulations should require cigarette manufacturers to gradually reduce nicotine content of all cigarettes sold in the U.S.
Scientists have conducted studies to test nicotine-reduction strategies, using commercial low-yield cigarettes. Such cigarettes do reduce nicotine yield when tested by smoking machines because manufacturers have engineered the cigarettes to burn faster, and they have used highly porous paper and ventilation holes above the filter. These cigarettes contain significant levels of nicotine and such "cigarette engineering" does not lead to decreased nicotine intake, because smokers are easily able to obtain the nicotine by taking more frequent and bigger puffs, Benowitz and his co-authors noted.
In contrast, in the new study, the absolute content of nicotine in the tobacco was reduced so that it was very difficult or impossible to compensate by smoking more intensely.
In addition to the reduced smoking and nicotine levels, the UCSF scientists looked for changes in exposure to carbon monoxide, tobacco smoke carcinogens and cardiovascular disease risk factors. All these remained stable or decreased, indicating that smokers were not exposed to higher levels of tobacco smoke toxins when they switched, and therefore would not be put at risk by a nicotine reduction intervention.
Benowitz and his colleagues are now conducting a much larger and longer clinical study on the effectiveness and safety of reducing nicotine levels in cigarettes. They plan also to examine whether reduced-nicotine cigarettes result in reduced addiction potential among adolescent experimental smokers.
The study was funded by the National Cancer Institute, National Institute on Drug Abuse, California Tobacco Research Program, and Division of Research Resources, National Institutes of Health.
Collaborators with Benowitz on the study and co-authors on the paper are UCSF researchers Sharon M. Hall, PhD; Susan Stewart, PhD; Margaret Wilson, MS; Delia Dempsey, MD, and Peyton Jacob III, PhD. Benowitz, Wilson, Dempsey and Jacobs are based at SFGH.
UCSF is a leading university dedicated to defining health worldwide through advanced biomedical research, graduate level education in the life sciences and health professions, and excellence in patient care.
Source: Wallace Ravven
University of California - San Francisco
среда, 25 мая 2011 г.
The Accuracy Of Personal Breathalyzers - Lifeloc Technologies Releases New Research
Lifeloc Technologies, Inc., a leading manufacturer of professional breathalyzers has released the industry's first independent report on the accuracy and reliability of popular semiconductor (silicone oxide) breath testers sold in mass retail, pharmacy, specialty stores and on the Internet.
"Anecdotal reports and experiences of consumers, law enforcement and other industry players have centered on the inaccuracy of semiconductor alcohol testers," said Barry Knott, president of Lifeloc. "New third party research has confirmed that popular semiconductor personal breathalyzers are notoriously inaccurate and should not be trusted for accurate BAC measurement. What we didn't know, until the test results came in, was just how inaccurate these devices are."
The report also exposes questionable marketing practices of consumer breathalyzer distributors and retailers whose advertising claims suggest a high level of BAC measurement accuracy that is not supported by the test results.
"This report should serve as a warning to consumers to avoid semiconductor breath testers if they want accurate BAC measurement. It's also an invitation to retailers to take more responsibility in how they market personal breathalyzers," said Knott. "Consumer and public safety is not being well served by misleading product claims."
The report entitled "An Evaluation of the Accuracy and Reliability of Popular Consumer Breathalyzers as compared to their Marketing Statements" is of interest to anyone considering the purchase or sale of personal semiconductor breath testers. It is available for free download from lifeguardbreathtester, or lifeloc.
Source:
Tammy Stratton
Lifeloc Technologies, Inc.
"Anecdotal reports and experiences of consumers, law enforcement and other industry players have centered on the inaccuracy of semiconductor alcohol testers," said Barry Knott, president of Lifeloc. "New third party research has confirmed that popular semiconductor personal breathalyzers are notoriously inaccurate and should not be trusted for accurate BAC measurement. What we didn't know, until the test results came in, was just how inaccurate these devices are."
The report also exposes questionable marketing practices of consumer breathalyzer distributors and retailers whose advertising claims suggest a high level of BAC measurement accuracy that is not supported by the test results.
"This report should serve as a warning to consumers to avoid semiconductor breath testers if they want accurate BAC measurement. It's also an invitation to retailers to take more responsibility in how they market personal breathalyzers," said Knott. "Consumer and public safety is not being well served by misleading product claims."
The report entitled "An Evaluation of the Accuracy and Reliability of Popular Consumer Breathalyzers as compared to their Marketing Statements" is of interest to anyone considering the purchase or sale of personal semiconductor breath testers. It is available for free download from lifeguardbreathtester, or lifeloc.
Source:
Tammy Stratton
Lifeloc Technologies, Inc.
вторник, 24 мая 2011 г.
Addiction Treatment May Benefit From Nicotine-Alcohol Interaction Study
The interaction between nicotine and alcohol, two of the most abused and co-abused drugs, can impact a person's ability to learn and could have implications for treating addiction, according to researchers at Temple University.
The researchers, Thomas J. Gould and Danielle Gulick, presented their findings, "Acute, chronic, and withdrawal from chronic nicotine interacts with acute ethanol to modulate fear conditioning," at the annual meeting of the Society for Neuroscience in San Diego. The study has also been accepted for publication in the peer-reviewed journal, Psychopharmacology.
"Whenever someone uses these two drugs together, there must be a reason why," says Gould, an associate professor of psychology at Temple. "The goal of our research is to understand the interactive effects of these two drugs and, by understanding how they are altering behavior and producing neural changes, we will hopefully be in a better position to develop treatments for drug addiction."
In examining the drugs' interactive effects on learning, the researchers looked at the ability to learn and process contextual information, which is important for multiple reasons. According to Gould, contextual learning taps into the part of the brain that is involved in declarative memory processes that define who we are, such as memories of our family, our wedding day, or graduating from school. This type of learning involves an area of the brain called the hippocampus, an area that is involved in strengthening short-term memories, and putting them into long-term memory storage, thus making those memories the ones that define who we are.
"We wanted to see if nicotine and alcohol are interacting in the hippocampus, or at another level, and what processes within the brain are they interacting with," Gould says. "If we can understand how these neural processes are changing and how they interact, then when someone is going through withdrawal or experiencing a cognitive deficit because of one of these two substances, we then may be able to use a therapeutic that blocks or activates a receptor, or that blocks a certain pathway which prevents the occurrence of the withdrawal symptoms and falling back into relapse."
Using an animal model, Gould and Gulick examined the effects of alcohol and nicotine on learning to determine what happens as the drugs are combined at different doses and different stages of administration.
"Our study showed that initially nicotine in a dose-dependent manner reverses alcohol-induced deficits in learning, but tolerance develops for this effect of nicotine with continued administration," he says. "We also found that a low dose of alcohol reverses nicotine withdrawal-associated deficits in learning. Furthermore, we found that chronic nicotine produces cross-tolerance to the effects of a low dose of alcohol on learning."
What does this all mean in terms of addiction?
"Think of a situation in which somebody is drinking and having cognitive difficulties," says Gould. "Smoking may take the edge off of it at first, so they begin smoking and they smoke more and more until tolerance develops and they lose that edge.
"Now they are drinking and smoking and they are addicted to both," he adds. "But if they try to quit smoking, they go into nicotine withdrawal, which results in a learning deficit. Maybe a drink will actually help them out initially, but then they consume more and they develop even worse learning deficits, so now they begin smoking again and they end up relapsing."
According to Gould, this could feed into a spiral in which initially nicotine and alcohol each block the adverse effects of the other. But as that happens, he says, smokers and drinkers develop tolerance and consume greater amounts of each drug, and then when they try quitting one or the other, they then have this cognitive deficit and may reach for either alcohol or nicotine or both to try and reverse it, but they just spiral into the addiction again.
This study was funded by the National Institute on Alcoholism and Alcohol Abuse (NIAAA) and the National Institute on Drug Abuse (NIDA).
Source: Preston M. Moretz
Temple University
The researchers, Thomas J. Gould and Danielle Gulick, presented their findings, "Acute, chronic, and withdrawal from chronic nicotine interacts with acute ethanol to modulate fear conditioning," at the annual meeting of the Society for Neuroscience in San Diego. The study has also been accepted for publication in the peer-reviewed journal, Psychopharmacology.
"Whenever someone uses these two drugs together, there must be a reason why," says Gould, an associate professor of psychology at Temple. "The goal of our research is to understand the interactive effects of these two drugs and, by understanding how they are altering behavior and producing neural changes, we will hopefully be in a better position to develop treatments for drug addiction."
In examining the drugs' interactive effects on learning, the researchers looked at the ability to learn and process contextual information, which is important for multiple reasons. According to Gould, contextual learning taps into the part of the brain that is involved in declarative memory processes that define who we are, such as memories of our family, our wedding day, or graduating from school. This type of learning involves an area of the brain called the hippocampus, an area that is involved in strengthening short-term memories, and putting them into long-term memory storage, thus making those memories the ones that define who we are.
"We wanted to see if nicotine and alcohol are interacting in the hippocampus, or at another level, and what processes within the brain are they interacting with," Gould says. "If we can understand how these neural processes are changing and how they interact, then when someone is going through withdrawal or experiencing a cognitive deficit because of one of these two substances, we then may be able to use a therapeutic that blocks or activates a receptor, or that blocks a certain pathway which prevents the occurrence of the withdrawal symptoms and falling back into relapse."
Using an animal model, Gould and Gulick examined the effects of alcohol and nicotine on learning to determine what happens as the drugs are combined at different doses and different stages of administration.
"Our study showed that initially nicotine in a dose-dependent manner reverses alcohol-induced deficits in learning, but tolerance develops for this effect of nicotine with continued administration," he says. "We also found that a low dose of alcohol reverses nicotine withdrawal-associated deficits in learning. Furthermore, we found that chronic nicotine produces cross-tolerance to the effects of a low dose of alcohol on learning."
What does this all mean in terms of addiction?
"Think of a situation in which somebody is drinking and having cognitive difficulties," says Gould. "Smoking may take the edge off of it at first, so they begin smoking and they smoke more and more until tolerance develops and they lose that edge.
"Now they are drinking and smoking and they are addicted to both," he adds. "But if they try to quit smoking, they go into nicotine withdrawal, which results in a learning deficit. Maybe a drink will actually help them out initially, but then they consume more and they develop even worse learning deficits, so now they begin smoking again and they end up relapsing."
According to Gould, this could feed into a spiral in which initially nicotine and alcohol each block the adverse effects of the other. But as that happens, he says, smokers and drinkers develop tolerance and consume greater amounts of each drug, and then when they try quitting one or the other, they then have this cognitive deficit and may reach for either alcohol or nicotine or both to try and reverse it, but they just spiral into the addiction again.
This study was funded by the National Institute on Alcoholism and Alcohol Abuse (NIAAA) and the National Institute on Drug Abuse (NIDA).
Source: Preston M. Moretz
Temple University
понедельник, 23 мая 2011 г.
Changing the face of drug addiction treatment, Rockefeller University researchers
People addicted to heroin, alcohol and other drugs of abuse often fail to stay clean because they won't go to or won't
stay in treatment. Reporting in the January issue of the Journal of Substance Abuse Treatment, Scott Kellogg, Ph.D., and Mary
Jeanne Kreek, M.D., at The Rockefeller University, and colleagues at the New York City Health and Hospitals Corporation (HHC)
and at Johns Hopkins University, show that a treatment approach called contingency management improves patients' motivation
to stay in treatment and increases their therapeutic progress.
The new study is one of the largest ever done to examine the merits of contingency management, a positive-reinforcement
treatment method in which patients are given rewards for constructive actions taken towards their recovery, for treating
addiction.
"This type of behavior research will help us understand what type of treatments and interventions, often used in conjunction
with targeted specific pharmacotherapies such as methadone for opiate addiction, are effective and how they can be translated
into real life," says Kreek, Patrick E. and Beatrice M. Haggerty Professor and head of the Laboratory on the Biology of
Addictive Disease.
The Journal of Substance Abuse Treatment paper tells the story of a transformation within the system, says Kellogg, who is a
clinical psychologist in Kreek's laboratory.
"We are hoping this study, which describes the experience of using contingency management from the vantage point of each
group of participants, will inspire other people to think that this is something that they might want to bring into their
clinic or their treatment system," he says. "To transform the field, we need to have both numbers and the stories. Together,
this is a powerful mechanism for change."
The intervention was first used in the addiction field in the mid-60s with alcoholic patients. The treatment was partially
based on the behaviorist B. F. Skinner's idea of operant conditioning, which proposes that behavior is more likely to
continue if it is reinforced. In the mid-70's, Maxine Stitzer, Ph.D., from Johns Hopkins University and a co-author of this
paper, began to test the effectiveness of this theory and intervention method on patients addicted to drugs.
"There was a debate between the scientific and the traditional worlds of drug treatment," says Kellogg. "At first, the
traditionalists were not able to take in a behavioral perspective as they saw addiction as an innate disease; therefore
external circumstances should not affect an addicted person's behavior. But those ideas are changing now, and that change is
part of our story."
The National Institute of Drug Addiction (NIDA) developed the Clinical Trials Network to both test and publicize various
science-based addiction treatments, and the contingency management program was one of the first chosen to study. At a
conference sponsored by NIDA, Kellogg, who is the scientific director for the contingency management intervention in New
York, met Peter Coleman and Marylee Burns, from the Office of Behavioral Health at the HHC, who are contributing authors to
the paper. Their meeting produced one of the largest adoptions ever done of contingency management, which involved five
addiction clinics in New York City.
"The Health and Hospitals Corporation was already preparing to apply something similar to the contingency management
approach," Kellogg says. "They were thinking of giving people rewards when they reached significant treatment benchmarks,
such as holding a job for six months. Using the science of operant conditioning, we suggested to them that you could achieve
a better outcome if you don't simply reward the attainment of goals, but, instead, you reinforce all of the steps along the
way."
"Scott developed the concept of a modified, practical but formal contingency management intervention within a community-based
treatment setting," Kreek says, "and he educated people at the HHC so they could implement it."
Contingency management is designed to reinforce small steps, especially at the beginning, like celebrating each attendance at
a group meeting or each drug-free test result. Later, patients can move on to larger achievements like stable housing.
Easy-to-earn material goods, such as movie passes and food vouchers, help to both initiate and maintain positive changes. The
program is not thought of as a substitute for counseling or pharmacotherapy, but something that adds to the therapy.
Documentation for the study included not only collected data, but also letters from patients and videotaped interviews with
staff and patients. Kellogg remembers one patient saying, "I felt like I was going down the drain with drug use, that I was
going to die soon. This [intervention] got me connected, got me involved in groups and back into things. Now I'm clean and
sober."
"We did have some opposition at first from the staff, people who come from different therapeutic traditions," Kellogg says.
"In general, we tend to punish people for doing things that are wrong, so it's not necessarily intuitive to reinforce
positive behavior when it does occur in our patients. But once the patients began to respond to the reinforcements, it
changed the counselors. The counselors want the patients to get better, and when they saw the patients get better, it was
really persuasive."
"I've heard several patients say 'My life has changed, I'm feeling better,'" he says. "It is so powerful to hear, so powerful
to witness. I would love to see the whole treatment system adopt this intervention."
This research was supported in part by the National Institute on Drug Abuse. Joyce B. Wale from the New York Health and
Hospitals Corporation also contributed to this paper.
Contact: Kristine Kelly
kkellyrockefeller
212-327-7146
Rockefeller University
rockefeller
stay in treatment. Reporting in the January issue of the Journal of Substance Abuse Treatment, Scott Kellogg, Ph.D., and Mary
Jeanne Kreek, M.D., at The Rockefeller University, and colleagues at the New York City Health and Hospitals Corporation (HHC)
and at Johns Hopkins University, show that a treatment approach called contingency management improves patients' motivation
to stay in treatment and increases their therapeutic progress.
The new study is one of the largest ever done to examine the merits of contingency management, a positive-reinforcement
treatment method in which patients are given rewards for constructive actions taken towards their recovery, for treating
addiction.
"This type of behavior research will help us understand what type of treatments and interventions, often used in conjunction
with targeted specific pharmacotherapies such as methadone for opiate addiction, are effective and how they can be translated
into real life," says Kreek, Patrick E. and Beatrice M. Haggerty Professor and head of the Laboratory on the Biology of
Addictive Disease.
The Journal of Substance Abuse Treatment paper tells the story of a transformation within the system, says Kellogg, who is a
clinical psychologist in Kreek's laboratory.
"We are hoping this study, which describes the experience of using contingency management from the vantage point of each
group of participants, will inspire other people to think that this is something that they might want to bring into their
clinic or their treatment system," he says. "To transform the field, we need to have both numbers and the stories. Together,
this is a powerful mechanism for change."
The intervention was first used in the addiction field in the mid-60s with alcoholic patients. The treatment was partially
based on the behaviorist B. F. Skinner's idea of operant conditioning, which proposes that behavior is more likely to
continue if it is reinforced. In the mid-70's, Maxine Stitzer, Ph.D., from Johns Hopkins University and a co-author of this
paper, began to test the effectiveness of this theory and intervention method on patients addicted to drugs.
"There was a debate between the scientific and the traditional worlds of drug treatment," says Kellogg. "At first, the
traditionalists were not able to take in a behavioral perspective as they saw addiction as an innate disease; therefore
external circumstances should not affect an addicted person's behavior. But those ideas are changing now, and that change is
part of our story."
The National Institute of Drug Addiction (NIDA) developed the Clinical Trials Network to both test and publicize various
science-based addiction treatments, and the contingency management program was one of the first chosen to study. At a
conference sponsored by NIDA, Kellogg, who is the scientific director for the contingency management intervention in New
York, met Peter Coleman and Marylee Burns, from the Office of Behavioral Health at the HHC, who are contributing authors to
the paper. Their meeting produced one of the largest adoptions ever done of contingency management, which involved five
addiction clinics in New York City.
"The Health and Hospitals Corporation was already preparing to apply something similar to the contingency management
approach," Kellogg says. "They were thinking of giving people rewards when they reached significant treatment benchmarks,
such as holding a job for six months. Using the science of operant conditioning, we suggested to them that you could achieve
a better outcome if you don't simply reward the attainment of goals, but, instead, you reinforce all of the steps along the
way."
"Scott developed the concept of a modified, practical but formal contingency management intervention within a community-based
treatment setting," Kreek says, "and he educated people at the HHC so they could implement it."
Contingency management is designed to reinforce small steps, especially at the beginning, like celebrating each attendance at
a group meeting or each drug-free test result. Later, patients can move on to larger achievements like stable housing.
Easy-to-earn material goods, such as movie passes and food vouchers, help to both initiate and maintain positive changes. The
program is not thought of as a substitute for counseling or pharmacotherapy, but something that adds to the therapy.
Documentation for the study included not only collected data, but also letters from patients and videotaped interviews with
staff and patients. Kellogg remembers one patient saying, "I felt like I was going down the drain with drug use, that I was
going to die soon. This [intervention] got me connected, got me involved in groups and back into things. Now I'm clean and
sober."
"We did have some opposition at first from the staff, people who come from different therapeutic traditions," Kellogg says.
"In general, we tend to punish people for doing things that are wrong, so it's not necessarily intuitive to reinforce
positive behavior when it does occur in our patients. But once the patients began to respond to the reinforcements, it
changed the counselors. The counselors want the patients to get better, and when they saw the patients get better, it was
really persuasive."
"I've heard several patients say 'My life has changed, I'm feeling better,'" he says. "It is so powerful to hear, so powerful
to witness. I would love to see the whole treatment system adopt this intervention."
This research was supported in part by the National Institute on Drug Abuse. Joyce B. Wale from the New York Health and
Hospitals Corporation also contributed to this paper.
Contact: Kristine Kelly
kkellyrockefeller
212-327-7146
Rockefeller University
rockefeller
воскресенье, 22 мая 2011 г.
Gender And Genes May Determine Effectiveness Of Treatment For Alcohol Dependence
Results from a new study suggest that one of the most prescribed medications for alcohol dependence may be more effective in some people. Preliminary results show that naltrexone (Revia), one of the only medications approved for treating people with alcohol abuse problems, may only be effective in women and those with a specific genetic variation. The new study, conducted by researchers from the Research Institute of the McGill University Health Centre (RI MUHC) and McGill University, will be published in the journal Alcoholism: Clinical and Experimental Research.
Previous work suggested that naltrexone only helped some people with alcohol problems, but the reason for that was unclear. "Our results suggest that we might now be able to predict beforehand who will benefit most," says Dr. Marco Leyton, lead investigator of the study and a researcher in the Mental Illnesses and Addiction axis at the RI MUHC. "We were quite excited to find that our results supported that naltrexone was specifically effective in women and in people who carried a gene related to the brain's natural morphine system called the mu opioid receptor gene (OPRM1)."
In this study, researchers followed a small group of "social drinkers" in an effort to validate some very preliminary hints that the efficacy of the treatment might be related to gender and a particular gene that may be inherited. These findings could help ensure that we give the right medication to the right people," says Dr. Leyton, who is also and associate professor in the Department of Psychiatry at McGill.
Researchers and clinicians might be able to determine who might best respond to this treatment, before it was administrated. "If a particular individual with alcohol dependence had these features, we could then say with much more confidence that this is going to help you. For other individuals who don't have those features, we'll be able to say, don't waste your time with this medication, we should try something else for you", explains Dr. Leyton. "These findings have the potential to improve the quality of treatment for alcohol dependent patients and they could ultimately lead to a form of personalized medicine."
Alcohol stimulates the release of the brain's natural opioids, which conveys a feeling of euphoria in individuals when drinking alcohol. There seem to be individual differences in the magnitude of that effect as well as in the sensitivity of the receptors to those natural opioids. "In other words, an opioid receptor blocker, such as naltrexone, might be an effective treatment for people with alcohol problems by decreasing the euphoria of drinking," explains Ms. Elaine Setiawan, first author of the study and PhD candidate in McGill's Integrated Program in Neuroscience.
At this point there is no particular reason to think that these findings couldn't be applied to other groups, such as those with a family history of alcoholism or those with high alcohol craving. But as Dr. Leyton suggests, "further research needs to be done in all sorts of populations and with a much larger sample to better understand the connection between the brain's opioid system, genetics and different responses to naltrexone."
About the paper:
The study entitled "The Effect of Naltrexone on Alcohol's Stimulant Properties and Self-Administration Behavior in Social Drinkers: Influence of Gender and Genotype" was supported by McGill University, the Canadian Institutes of Health Research (CIHR), and GlaxoSmithKline Inc. The co-authors of the study are Sylvia M.L. Cox of the Department of Neurology and Neurosurgery at McGill University; Robert O. Pihl of the Department of Psychology and the Department of Psychiatry at McGill University; Christina Gianoulakis and Roberta M. Palmour of the Department of Psychiatry at McGill University; and Chawki Benkelfat of the Department of Neurology and Neurosurgery, and the Department of Psychiatry at McGill University.
Source:
Julie Robert
McGill University Health Centre
View drug information on Naltrexone Hydrochloride Tablets.
Previous work suggested that naltrexone only helped some people with alcohol problems, but the reason for that was unclear. "Our results suggest that we might now be able to predict beforehand who will benefit most," says Dr. Marco Leyton, lead investigator of the study and a researcher in the Mental Illnesses and Addiction axis at the RI MUHC. "We were quite excited to find that our results supported that naltrexone was specifically effective in women and in people who carried a gene related to the brain's natural morphine system called the mu opioid receptor gene (OPRM1)."
In this study, researchers followed a small group of "social drinkers" in an effort to validate some very preliminary hints that the efficacy of the treatment might be related to gender and a particular gene that may be inherited. These findings could help ensure that we give the right medication to the right people," says Dr. Leyton, who is also and associate professor in the Department of Psychiatry at McGill.
Researchers and clinicians might be able to determine who might best respond to this treatment, before it was administrated. "If a particular individual with alcohol dependence had these features, we could then say with much more confidence that this is going to help you. For other individuals who don't have those features, we'll be able to say, don't waste your time with this medication, we should try something else for you", explains Dr. Leyton. "These findings have the potential to improve the quality of treatment for alcohol dependent patients and they could ultimately lead to a form of personalized medicine."
Alcohol stimulates the release of the brain's natural opioids, which conveys a feeling of euphoria in individuals when drinking alcohol. There seem to be individual differences in the magnitude of that effect as well as in the sensitivity of the receptors to those natural opioids. "In other words, an opioid receptor blocker, such as naltrexone, might be an effective treatment for people with alcohol problems by decreasing the euphoria of drinking," explains Ms. Elaine Setiawan, first author of the study and PhD candidate in McGill's Integrated Program in Neuroscience.
At this point there is no particular reason to think that these findings couldn't be applied to other groups, such as those with a family history of alcoholism or those with high alcohol craving. But as Dr. Leyton suggests, "further research needs to be done in all sorts of populations and with a much larger sample to better understand the connection between the brain's opioid system, genetics and different responses to naltrexone."
About the paper:
The study entitled "The Effect of Naltrexone on Alcohol's Stimulant Properties and Self-Administration Behavior in Social Drinkers: Influence of Gender and Genotype" was supported by McGill University, the Canadian Institutes of Health Research (CIHR), and GlaxoSmithKline Inc. The co-authors of the study are Sylvia M.L. Cox of the Department of Neurology and Neurosurgery at McGill University; Robert O. Pihl of the Department of Psychology and the Department of Psychiatry at McGill University; Christina Gianoulakis and Roberta M. Palmour of the Department of Psychiatry at McGill University; and Chawki Benkelfat of the Department of Neurology and Neurosurgery, and the Department of Psychiatry at McGill University.
Source:
Julie Robert
McGill University Health Centre
View drug information on Naltrexone Hydrochloride Tablets.
суббота, 21 мая 2011 г.
Heavy Marijuana Use And Schizophrenia Risk
Heavy use of marijuana may put adolescents who are genetically predisposed to schizophrenia at greater risk of developing the brain disorder, according to research presented today at the annual meeting of the Radiological Society of North America (RSNA).
Using a sophisticated brain imaging technique called diffusion tensor imaging (DTI), researchers at Zucker Hillside Hospital in Glen Oaks, New York, studied the brains of groups of adolescents: healthy, non-drug users; heavy marijuana smokers (daily use for at least one year); and schizophrenic patients. Unlike magnetic resonance imaging (MRI), which provides a static picture of brain structures, DTI detects and measures the motion of water molecules in the brain, which can reveal microscopic abnormalities.
Manzar Ashtari, Ph.D., Sanjiv Kumra, M.D., and colleagues used DTI to examine the arcuate fasciculus, a bundle of fibers connecting the Broca's area in the left frontal lobe and the Wernicke's area in the left temporal lobe of the brain. The investigators found that repeated exposure to marijuana was related to abnormalities in the development of this fiber pathway, which is associated with the higher aspects of language and auditory functions.
"Because this language/auditory pathway continues to develop during adolescence, it is most susceptible to the neurotoxins introduced into the body through marijuana use," explained Dr. Ashtari, associate professor of radiology and psychiatry at New York's Albert Einstein College of Medicine.
In the study, DTI was performed on 12 healthy, early adolescent males compared with 12 late adolescent males to show normal human brain development; 11 schizophrenic patients compared with 17 matched controls; 15 schizophrenic patients who smoke marijuana compared with 17 matched controls; and 15 marijuana smokers compared with 15 matched non-drug users. The scans revealed no abnormal developmental changes in the language pathway in the healthy adolescents, but showed abnormalities in both the marijuana users and schizophrenic patients.
"These findings suggest that in addition to interfering with normal brain development, heavy marijuana use in adolescents may also lead to an earlier onset of schizophrenia in individuals who are genetically predisposed to the disorder," said co-principal-investigator Sanjiv Kumra, M.D., assistant professor of psychiatry at Albert Einstein College of Medicine.
According to the National Institute on Drug Abuse, approximately 3.1 million Americans age 12 and older use marijuana on a daily or almost daily basis. In 2004, 5.6 percent of 12 th graders reported daily use of marijuana.
Schizophrenia is a chronic, severe and disabling brain disorder that affects about one percent of the entire population. Although the causes of the disease have not been determined, it is believed to result from a combination of environmental and genetic factors.
Drs. Ashtari and Kumra said longitudinal studies are needed to determine whether these changes in the brain are permanent or change over time. It is also important to mention that at this time, DTI and MRI are not diagnostic means for schizophrenia patients or marijuana smokers.
Co-authors are Jinghui Wu, B.S., Kelly Cervellione, M.A., John Kane, M.D., Philip Szeszko, Ph.D., and Babak Ardekani, Ph.D.
Maureen Morley
mmorleyrsna
Radiological Society of North America
rsna
Using a sophisticated brain imaging technique called diffusion tensor imaging (DTI), researchers at Zucker Hillside Hospital in Glen Oaks, New York, studied the brains of groups of adolescents: healthy, non-drug users; heavy marijuana smokers (daily use for at least one year); and schizophrenic patients. Unlike magnetic resonance imaging (MRI), which provides a static picture of brain structures, DTI detects and measures the motion of water molecules in the brain, which can reveal microscopic abnormalities.
Manzar Ashtari, Ph.D., Sanjiv Kumra, M.D., and colleagues used DTI to examine the arcuate fasciculus, a bundle of fibers connecting the Broca's area in the left frontal lobe and the Wernicke's area in the left temporal lobe of the brain. The investigators found that repeated exposure to marijuana was related to abnormalities in the development of this fiber pathway, which is associated with the higher aspects of language and auditory functions.
"Because this language/auditory pathway continues to develop during adolescence, it is most susceptible to the neurotoxins introduced into the body through marijuana use," explained Dr. Ashtari, associate professor of radiology and psychiatry at New York's Albert Einstein College of Medicine.
In the study, DTI was performed on 12 healthy, early adolescent males compared with 12 late adolescent males to show normal human brain development; 11 schizophrenic patients compared with 17 matched controls; 15 schizophrenic patients who smoke marijuana compared with 17 matched controls; and 15 marijuana smokers compared with 15 matched non-drug users. The scans revealed no abnormal developmental changes in the language pathway in the healthy adolescents, but showed abnormalities in both the marijuana users and schizophrenic patients.
"These findings suggest that in addition to interfering with normal brain development, heavy marijuana use in adolescents may also lead to an earlier onset of schizophrenia in individuals who are genetically predisposed to the disorder," said co-principal-investigator Sanjiv Kumra, M.D., assistant professor of psychiatry at Albert Einstein College of Medicine.
According to the National Institute on Drug Abuse, approximately 3.1 million Americans age 12 and older use marijuana on a daily or almost daily basis. In 2004, 5.6 percent of 12 th graders reported daily use of marijuana.
Schizophrenia is a chronic, severe and disabling brain disorder that affects about one percent of the entire population. Although the causes of the disease have not been determined, it is believed to result from a combination of environmental and genetic factors.
Drs. Ashtari and Kumra said longitudinal studies are needed to determine whether these changes in the brain are permanent or change over time. It is also important to mention that at this time, DTI and MRI are not diagnostic means for schizophrenia patients or marijuana smokers.
Co-authors are Jinghui Wu, B.S., Kelly Cervellione, M.A., John Kane, M.D., Philip Szeszko, Ph.D., and Babak Ardekani, Ph.D.
Maureen Morley
mmorleyrsna
Radiological Society of North America
rsna
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