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Friday, February 17, 2017

Depression and E-Cigarette Initiation

Last week we covered an alarming new trend regarding e-cigarette use among young people, known as “dripping.” We felt it important to keep the conversation about e-cigs going, considering the device's growing popularity among young people.

Smoking cigarettes has long been associated with a form of stress release, much like having a beer at the end of long day. Who hasn’t known someone who, when stressed out, said aloud, “I need a cigarette.” People don't just smoke when they are stressed. They smoke to alleviate anxiety and depression, as well. Some even smoke to quell their appetite, at times. Such behaviors are often what addiction is built upon, associating a specific action with relief.

In the field of addiction medicine, it is quite common for patients who report their addiction being the result of self-medicating untreated mental illness, such as depression or bipolar disorder. Such instances are referred to as co-occurring disorders. When mental illness is left untreated, people will often look to potentially dangerous remedies, like drugs and alcohol. But let’s get back to nicotine for the time being.

In recent years, there has been a heated conversation about electronic cigarettes, specifically with regard to the benefits over traditional tobacco products and the potential health risks. It is fair to say that at the end of the day researchers (in most cases) do not yet have definitive answers regarding the pros and cons of e-cigarette use. While most will agree that e-cigs are likely a safer alternative to other methods of nicotine delivery, yet there is widespread concern in the health community about the impact of the vapor devices on young people.

Concerns have also been put forth of late regarding mental health and e-cigarette use. A study conducted by researchers at The University of Texas Health Science Center at Houston (UTHealth) showed a link between depression and initiation of e-cigarette use among college students, according to a UT press release. The findings were published in Nicotine & Tobacco Research.

While the researchers could not find evidence that e-cigarette use leads to elevated symptoms of depression, the study showed that college students who had had elevated levels of depressive symptoms were at a much greater risk of starting to use e-cigs, the article reports. The relationship was surprising to the researchers because the same could not be said for the relationship between depressive symptoms and traditional cigarette initiation.

"We don't know why depression leads to e-cigarette use. It may be self-medication. Just like with cigarettes, when students feel stressed out, using e-cigarettes may make them feel better. Or it could be that since e-cigarettes have been marketed as a smoking cessation device, depressed students may be using e-cigarettes to help them quit smoking traditional cigarettes," said lead author Frank Bandiera, Ph.D., assistant professor in the Department of Epidemiology, Human Genetics and Environmental Sciences at UTHealth School of Public Health in Dallas. 

The study was the first of its kind to establish a longitudinal relationship between the depression and e-cigarettes, according to the article. Further research will be needed to determine what the relationship means.

Friday, February 10, 2017

Teenage E-Cigarette Dripping

The e-cigarette conversation continues as more and more teenagers are using the devices. A 2015 survey found that 24 percent of high school students reported using e-cigarettes during the past 30 days, per the Centers for Disease Control and Prevention (CDC). While the Food and Drug Administration (FDA) has finally been given authority to regulate e-cigs, creating age restrictions, the devices are still being used by minors and young adults.

Most experts agree that electronic cigarettes are less harmful than other forms of nicotine delivery. However, nicotine is still addictive and can potentially start young people on the road to harmful behaviors that can lead to addiction. Furthermore, e-cig nicotine juices come in a number of flavors that can keep people coming back for more, where as traditional cigarettes have one flavor—you either like it or you don’t.

There have also been concerns raised about nicotine levels in e-cigarette “juices,” and how the devices are used. A new trend called “dripping,” allows e-cigarette users to get more bang for their buck, HealthDay reports. In fact, a survey shows that 1 in 4 teens have reported having tried dripping. So, what is dripping?

Normally, e-cigs users inhale to gradually draw the e-juice into a heating coil through what are known as “wicks,” creating a vapor, according to lead researcher Suchitra Krishnan-Sarin, a professor of psychiatry at Yale University School of Medicine in New Haven, Conn. "Dripping" is when e-cig users place drops of the nicotine juice directly onto the exposed heating coil and then quickly inhaling the thick vapor cloud produced. Krishnan-Sarin’s survey indicates that 26 percent of student e-cigarette users at eight Connecticut high schools has "dripped."

The immediate or long term health consequences of dripping are not known yet, according to the article. Although, the chief of general pediatrics of Mount Sinai Health System in New York City, Dr. Karen Wilson, says that the more potent nicotine could impact the developing brains of teenagers.

"Adolescents should not be using nicotine at all," Wilson said. "It changes the brain chemistry, and adolescents are uniquely susceptible to the addictive properties of nicotine." 

The findings of the report were published in Pediatrics.

Saturday, February 4, 2017

Curbing Alcohol Cravings With Ibudilast

In recent years, the drugs like Naltrexone and Acamprosate have been used to treat alcoholics. While such drugs are classified as opioid antagonists, they have been shown to be effective at reducing cravings for alcohol. The drugs have proven to be useful inside and outside addiction treatment settings.

Cravings for any mind-altering substance can be one’s downfall, often leading to relapse for those working programs of recovery. It is for that reason that keeping one's cravings in check is of the utmost importance. Urges to use can creep up on people, and before you know it, one’s behavior can regress back to old ways of thinking about things. Essentially paving a road to relapse. If people in recovery are open and honest with their peers about their cravings, relapse can be avoided. But that isn't always an easy task.

Arguably, in a perfect world there would exist a drug that stops cravings altogether in the first place. In the meantime, those recovering from addiction must continue to make do with drugs that reduce cravings. While Naltrexone and Acamprosate are effective for some people, with others that is not the case. Researchers continue to create new drugs that can reduce cravings, or research drugs that were intended for something else.

As per the latter, addiction researchers have been experimenting with a drug called ibudilast, and have found that it can significantly reduce alcohol cravings in heavy drinkers, PsychCentral reports. Ibudilast is an anti-inflammatory drug used to treat asthma, mainly in Japan. The findings were published in the journal Neuropsychopharmacology.

The study was conducted by researchers at the University of California Los Angeles (UCLA) and involved 17 men and seven women, according to the article. The participants reported drinking alcohol an average of 21 days per month and drinking seven alcoholic beverages per day when they drank. Study participants who were given ibudilast reported being in a better mood and having far less cravings for alcohol, than those who were not given the drug.

“We found that ibudilast is safe and well-tolerated,” said Dr. Lara Ray, a UCLA professor of psychology, director of the UCLA Addictions Laboratory and the study’s lead author. “This medication can be safely administered, including when people are drinking alcohol.” 

The researcher points out that none of the participants expressed a desire to quit drinking before the study. Moving forward, Dr. Ray plans on studying the drug with participants that are heavy drinkers who want to stop drinking.

Friday, January 27, 2017

Mary Tyler Moore's Alcoholism

Mary Tyler Moore passed away Wednesday, January 25, 2017, at the age of 80. Often referred to as “America’s Sweetheart,” Tyler Moore's life was nothing short of extraordinary; she starred in both hot movies and television shows, and championed a number of causes. Her life was also extraordinary in a tragic way as well, and is a perfect example of addiction being family disease—affecting multiple generations.

Mary Tyler Moore was born on Dec. 29, 1936, the daughter of two alcoholics, according to The New York Times. Her sister, Elizabeth Moore, died of a drug and alcohol overdose in 1978. Mary Tyler Moore would struggle with addiction as well over the years, and was treated for alcoholism at the Betty Ford Center in 1984. She would open up about her addiction in her memoir and during interviews.

In 2005, Larry King asked her how she beat alcoholism, to which she responded, “I just made up my mind to stop:”


MOORE: Well, I went to the Betty Ford Center and got a lot of education there and a lot of spirit and determination. Somebody said something -- it's a
--> cliché, you've heard it a 100 times, but they say if you want to get all the air out of a glass, what do you do? There's no way to do it but fill it with something else. And that something else is joy of living, reading, being creative, know you're doing the right thing. And that got me to thinking.
KING: Why didn't the joy of success work?

MOORE: I don't know.

KING: One doesn't know, does he?

MOORE: No. And, you know, with alcoholism, you tend to drink because you're angry, or you drink because you're sad now, or you drink because you are just so happy you want to celebrate.

There is not just one way to recover from the debilitating disease of addiction. Tyler Moore’s may not be the course another takes, but her story is inspirational to say the least. She came from a line of alcoholics and found a way to not let the disease be her end. The champion of women’s rights and the treatment of diabetes, she died at Greenwich Hospital in Connecticut of cardiopulmonary arrest.

If you or a loved one is struggling with an alcohol use disorder, please contact Celebrate Hope at Hope by The Sea. Our skilled team can show you how to live life without alcohol or any other mind-altering substances.

Thursday, January 19, 2017

Opioids With A History of Mental Illness

It may seem like common sense that people with a history of psychiatric illness would be more susceptible to developing an addiction, at least to those who work in the field of addiction medicine. However, many doctors do not look at a patient’s complete medical history before deciding whether to prescribe opioid painkillers, or not. Or so a new study has found. Such lapses regarding a patient's background can have devastating consequences on certain patients.

New research suggests that people with pre-existing psychiatric and behavioral conditions are at greater risk of long-term use of opioid pain medications, according to a press release. The findings highlight the need for providers to run complete histories on patients they are considering prescribing narcotics. The research was published in the Pain: The Journal of the International Association for the Study of Pain.

The researchers found that about 1.7 percent of patients prescribed opioids become long-term opioid users (six months or longer), according to the report. However, those with a history of mental health conditions or psychoactive medication use, became long-term opioid user at a much greater rate. The findings come from an analysis of data on prescriptions and health history for 10.3 million people, part of a nationwide insurance database, from 2004 to 2013.

"We found that pre-existing psychiatric and behavioral conditions and psychoactive medications were associated with subsequent claims for prescription opioids," study author Patrick D. Quinn, PhD, of Indiana University, Bloomington, and colleagues write. "Our findings support the ideas that clinical practice has deviated from the 'careful selection' under which most clinical trials are conducted and that thorough mental health assessment and intervention should be considered in conjunction with the use of long-term opioid therapy." 

In the field of addiction, it is quite common for people battling substance abuse to also have a co-occurring mental health disorder. Treatment becomes more complex because success depends on treating both the substance use and co-occurring disorder. So, it stands to reason that prescribing opioids to people who are already likely to be more susceptible to addiction, may not be a good choice. Looking for opioid alternatives when treating the pain of patients with history of mental illness or substance use, would have a positive effect all around.

Thursday, January 12, 2017

Addicts Make Riskier Decisions

It is hardly a secret that people who abuse drugs and alcohol often make rash decisions that can greatly impact their life. People under the influence of alcohol will often choose to get behind the wheel of a car. Heroin addicts will inject another dose despite the risk of overdose, while already sufficiently intoxicated. Inside each addict and alcoholic is a force that is not acting with their well-being in mind.

Researchers continue to probe the mind to better understand what is operating. And in some cases, they would like to better understand the decision-making product of people with substance use disorders. New findings suggest that cocaine addicts make riskier decisions, because of an exaggerated decrease in the reward processing region of the brain, according to a press release. The findings were published in the journal Biological Psychiatry: Cognitive Neuroscience and Neuroimaging.

The researchers came to their findings by using gambling models, or what are known as a Risky Gains Task, according to the report. They compared the data from 29 people diagnosed with cocaine use disorder to 40 control participants. The participants were asked to perform a Risky Gains Task, where they could earn money by selecting between three monetary values -- the lowest value being the safest option and higher values being riskier. While undergoing the task, participants' behaviors were observed and neuroimaging was conducted. The findings could lead to a way of tracking the progress of a cocaine addicts recovery.

"This paradoxical relationship between how someone acts in response to a loss can give us clues for how to develop better interventions and how to track the recovery of the brain from cocaine addiction," said first author Joshua Gowin, of the University of California San Diego. 

Observations indicated that as potential monetary value increased, the control group and cocaine addict group made different choices. Neuroimaging showed a proportional increase in activity of the ventral striatum in the brains of the control group, not seen in the cocaine use disorder group, the article reports. The ventral striatum is believed to be important for processing of rewards. The researchers believe that the risky behavior exhibited by cocaine addicts was not motivated by reward.

"In an interesting parallel to their real life behavior, brain activity and choice behavior during a gambling task used in this study indicate an aberrant sensitivity to loss and a tendency to double down and make risky choices," said Cameron Carter, Editor of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging.

Thursday, January 5, 2017

Cocaine, Heroin and Overdose

For an addict, there is such a thing as “more high.” Even if tolerance says otherwise. With some drugs, such as marijuana, a continued effort to increase one’s euphoria may not be that dangerous. But for drugs like prescription opioids or heroin, riding the line between intoxication and overdose is never in one's best interest—but highly sought after. What is considered to be a good high, can quickly turn into a deadly overdose.

The death toll related to drug abuse is almost always focused on opioid narcotics these days. While such drugs do not need any help with regard to being dangerous, addicts will commonly mix opioids with other narcotics, sometimes “uppers” and sometimes with more “downers.” It is quite common for people who mix opioids with benzodiazepines to experience a fatal overdose. However, there is another trend that has the power to take one’s life, commonly referred to as “speedballing.” That is mixing opioids and cocaine together, to be injected simultaneously. You may be aware that a number of celebrities have lost their life to the admixture, including:
  • John Belushi
  • Chris Farley
  • Philip Seymour Hoffman
The general public almost never hears about cocaine anymore, being overshadowed by drugs like heroin and fentanyl. If you did hear about cocaine, it is likely that it was because somebody famous died using the drug recently. But make no mistake, cocaine abuse is still a very real problem affecting many Americans. And for those with an opioid use disorder, who are finding that their tolerance is making it difficult to experience euphoria, cocaine might be the solution they consider. Anyone who has ever done a speedball will tell you that there is no other high quite like it, or as dangerous.

While cocaine use rates have been down in recent years, the U.S. Drug Enforcement Agency's (DEA) 2016 National Drug Threat Assessment has shown a significant increase in cocaine-related overdose deaths in recent years, according to the U.S. News & World Report. Cocaine can be deadly on its own; but when mixed with opioids the drug becomes exponentially more fatal.

“When there are no opioids involved in cocaine-overdose deaths you see an overall decline in recent years,” says Christopher M. Jones, an acting associate deputy assistant secretary with the Department of Health and Human Services. “But when you look at cocaine and opioids together, we see a more than doubling in the number of overdoses since 2010, with heroin and synthetic opioids increasingly involved in these deaths."
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