With Arizona facing a critical crisis of methamphetamine use, Dr. Gregory Ellison, Director of Advanced Medical Center, has identified a very promising new addiction treatment option that shows high success rates and is performed on an out-patient (versus in-patient) basis in 10 hours over five sessions. As the only doctor in the state of Arizona licensed to administer the new PROMETA(R) treatment program, Ellison is encouraged with results of clinic trials which show more than a 60 percent success rate.

In conjunction with the statewide television simulcast of Crystal Darkness on April 15th to raise awareness about meth, there is a mandate to raise awareness about addiction treatment. Ellison’s PROMETA(R) 30-day program targets the imbalances in the brain chemistry associated with substance dependence, cravings, tolerance, withdrawal symptoms and relapse with a three-prong treatment of medicine, nutrition and psychology. Patients receiving this treatment experience:

– Relief from cravings and anxiety

– Restoration of nutritional balance

– Improvement of mental capacity

Unlike many in-patient therapies, Ellison’s PROMETA(R) program is done on an out-patient basis, allowing individuals to continue their daily lives and removing the stigma of “going to rehab.” With the number of Arizonians seeking treatment for meth addiction quintupling between 2000 and 2004, out-patient capabilities not only positively impact individuals and their families, but the community and its resources as well.

More than 60 percent of patients participating in clinical trials successfully kicked their addiction, while 97 percent reported a decrease in frequency of cravings. In a study just published by Community Bridges in Arizona, the findings showed 86 percent of patients in the PROMETA(R) program versus less than 10 percent in other intensive outpatient programs were still actively participating in recovery counseling 16 weeks later.

In 2007, Advanced Medical Center’s fully-trained staff became one of only 60 practices nationwide to offer the PROMETA(R) program for treatment of alcohol, cocaine and methamphetamine dependence. This medically-supervised treatment program is designed to address both the neurochemical imbalances in the brain and some of the nutritional deficits caused or worsened by chronic substance abuse.

Ellison’s PROMETA(R) program begins with a complete physical exam. The medically-supervised treatment encompasses oral and IV medications administered on three consecutive daily visits of about two hours each, plus two additional treatments approximately three weeks after the initial treatment. At-home prescription medications are also used for approximately one month. Nutritional supplements and counseling, based on nutritional guidelines for patients in recovery, are provided to establish healthy dietary habits designed to support recovery. Initial psychological counseling is offered immediately, based on a comprehensive assessment by Ellison, and may include individual, group or any form of 12-step or faith-based programs.

Ellison is a leading family and addiction medicine practitioner in Tempe, Arizona, with more than 25 years of experience. A fellow of the American Academy of Family Physicians, Dr. Ellison is a recognized leader in the field and offers a unique integrated approach to health care. Board Certified by the American Board of Family Medicine, Dr. Ellison has served on a number of professional organizations including the Maricopa County Board of Medical Directors and the Maricopa County Medical Grievance Committee.

Dr. Ellison is currently a member of the Arizona Medical Association, the American Society of Addictive Medicine and American Academy of Family Practice. He is also the chairman of the Desert Physicians Association.

Researchers have identified, for the first time, long-term changes in the brain circuitry of methamphetamine-addicted mice that can explain why the craving of addiction is so stubborn and long-lived. The research could lead to more effective treatments for addiction to methamphetamine and related drugs.

In their experiments, the researchers treated mice with methamphetamine and studied how long exposure to the drug affected levels of the brain chemical dopamine. Researchers have long known that methamphetamine and amphetamine enhance release of dopamine at the connections between neurons, called synapses. Dopamine is one of the brain’s major neurotransmitters, the chemical messengers by which one neuron triggers its neighbor to fire a nerve impulse.

The researchers concentrated on the dopamine machinery in the brain’s corticostriatal region, believed to harbor the “habit” circuitry central to the compulsive drug-seeking of addiction to methamphetamine and amphetamine.

To reveal the flow of dopamine, they used a fluorescent tracer dye that is taken up by the same microscopic sacs, called vesicles, that store and release dopamine in the process of signaling between neurons. Using microscopy to follow the movement of the dye, they could study how methamphetamine affected the dopamine transport machinery in the brain.

Their studies revealed that giving the animals the drug long enough to cause chronic effects caused a depression of the synaptic dopamine machinery in the corticostriatal region that lasted for months after the drug was withdrawn. However, giving the animals a dose of methamphetamine reversed the depressive effects on the synaptic machinery.

A new study finds that references to illegal drug use in rap music jumped sixfold in the two decades since 1979, the year Sugar Hill Gang’s “Rapper’s Delight” hit the charts and introduced to a mainstream audience a music genre born from inner-city America.

Moreover, illegal drug use became increasingly linked during this time period to wealth, glamour and social standing, marking a significant change from earlier years, when rap music was more likely to have depicted the dangers and negative consequences of drug abuse, according to the study authored by Denise Herd, associate professor in the division of Community Health and Human Development at the University of California, Berkeley’s School of Public Health.

“This trajectory in rap music raises a number of red flags,” said Herd, who also is associate dean for student affairs at the School of Public Health. “Rap music is especially appealing to young people, many of whom look up to rappers as role models. As a public health researcher, and as a parent of a 7-year-old, I’m concerned about the impact that long-term exposure to this music has on its listeners.”

The new study, published in the April issue of the peer-reviewed journal Addiction Research & Theory, is the first scientific survey to analyze the content of rap music over two decades.

Herd and her team examined the lyrics of 341 of the most popular rap songs – as determined by Billboard and Gavin music rating services – from 1979 to 1997. Researchers coded songs for drug mentions, behaviors and contexts surrounding the mention of drugs, as well as the attitudes and consequences stemming from illicit drug use.

Of the 38 most popular rap songs between 1979 and 1984, only four, or 11 percent, contained drug references. In the early 1990s, the percentage of rap songs with drug references experienced a sharp jump to 45 percent, and steadily increased to 69 percent of the 125 top rap songs between 1994 and 1997.

The study found that drug references in early rap songs – “White Lines” by Grandmaster Flash, “Crack Monster” by Kool Moe Dee and “Night of the Living Baseheads” by Public Enemy – often depicted the destructiveness of cocaine and, particularly, of crack, its freebase form.

This cautionary tone about cocaine gave way to rap lyrics in the early 1990s that increasingly portrayed marijuana use as a positive activity. The UC Berkeley study documented a threefold increase between 1979 and 1997 in rap songs’ mentions of marijuana and marijuana-stuffed cigars, or “blunts,” and noted marijuana’s association in those songs with creativity, wealth and status.

Herd noted that the study puts hard numbers to a trend that has long been noted anecdotally among observers of the music industry. She referenced a 1996 article in Vibe, a magazine that covers hip hop culture, highlighting the success of Cypress Hill’s 1991 debut album celebrating marijuana use as a turning point in rap music’s popularization of the drug. The Vibe article noted that other rap artists, including Dr. Dre and Snoop Dogg, soon followed suit with their own references to marijuana as an appealing drug to use.

Herd said that after rap albums celebrating marijuana use started going platinum in the early 1990s, drug references became increasingly common in rap music, as if they were a key ingredient to success.

“There is a common perception that drugs and rap music are inextricably linked, but that wasn’t always the case,” said Herd. “The fact that rap music didn’t always have those drug references is compelling because it shows that this music didn’t depend on that as an art form. The direction of the music seemed to change with the music’s growing commercial success.”

Herd’s analysis stopped at 1997, but she noted that a recent study suggests the continued prevalence of substance abuse references in contemporary rap music. That study, led by Dr. Brian Primack from the University of Pittsburgh’s School of Medicine, found that of Billboard’s 279 most popular songs in 2005, a staggering 77 percent of the 62 rap songs portrayed substance use, often in the context of peer pressure, wealth and sex. He also found that only four of the 279 songs analyzed contained an “anti-use” message, and none of them was in the rap category.

Notably, other music genres had far lower rates of substance abuse references. Country music came in a distant second to rap with 36 percent of songs referencing substance abuse.

Herd noted that the image that rap artists portray of drug use in the African American community distorts reality. “Young black people actually have similar or lower rates of drug and alcohol abuse compared with their white peers, but you wouldn’t guess that based upon the lyrics in rap music,” said Herd.

The reasons behind rap music’s shift in drug references are complex, said Herd. They may reflect the nuanced interplay of changes in the drug use habits of rappers and listeners – particularly the growing popularity of marijuana during the study period – greater commercialization of rap music, and the rise of gangsta rap and other rap music genres. It could also be a reflection of social rebellion stemming from the disproportionate punishment of African Americans in the U.S. government’s War on Drugs.

“Rap is inherently powerful,” said Herd. “It has experienced phenomenal growth in many sectors of society in this country and even abroad. Rap artists have become key role models and trendsetters, and their music serves as the CNN for our nation’s young people by providing them with a way to stay current. But we have to ask ourselves whether there are other kinds of messages rap music could deliver. We need to better understand how this trend got started so we can find effective ways to counter it.”

Herd did not study whether rap music’s glamorization of illegal drugs actually led to increased drug abuse, but the debate about the potentially negative influence on young people of various media, from movies to music to video games, that depict drug and alcohol use in a positive light is certainly not new.

Herd’s paper cited other studies linking certain movies and music videos to the onset of smoking, alcohol and drug use. One study specifically linked greater exposure to rap music videos to a greater risk of alcohol and drug use among adolescents over the next 12 months, while another survey associated the use of codeine-laced cough syrup among some at-risk Houston teens with an emerging form of rap music called “screw music,” in which cough medicine abuse was promoted.

“Most adults have very little idea about what’s going on in music these days,” said Herd. “This new study reinforces the need for adults to pay closer attention to the music children are listening to.”

This study is part of a larger research project analyzing changes in rap music funded by the Innovators Combating Substance Abuse program of The Robert Wood Johnson Foundation, the nation’s largest philanthropic organization devoted exclusively to health care.

Through this project, Herd published an earlier study that found a significant increase in references to alcohol in rap music over the years, and she is now analyzing rap music’s depiction of violence.

• Represents the first systematic and broadly based examination of the Gateway Hypothesis • Reflects multidisciplinary perspectives ranging from culture to biology and juxtaposes epidemiological, intervention, animal and neurobiological studies • Contributes to the empirical and theoretical literature on drug use patterns and progression
Contents

Part I. Overview: 1. Examining the gateway hypothesis: stages and pathways of drug involvement Denise B. Kandel; Part II. Recent Substantive Findings: What do we Know about Stages of Drug Use, Risks and Protective Factors? 2. Drug sequences, age of onset and use trajectories as predictors of drug abuse/dependence in young adulthood Erich Labouvie and Helene R. White; 3. Substance use norms and transitions in substance use: implications for the gateway hypothesis David Hawkins, Karl G. Hill, Jie Guo and Sara R. Battin-Pearson; 4. Stages of drug involvement in the US population Denise B. Kandel and Kazuo Yamaguchi; 5. Substance use progression and hard drug use in inner city New York Andrew Golub and Bruce D. Johnson; Part III. Impact of Prevention Interventions: a Test of the Progression Hypothesis: 6. Preventing the onset and developmental progression of adolescent drug use: implications for the gateway theory Gilbert Botvin, Kenneth Griffin and Lawrence Scheier; 7. The gateway theory applied to prevention Mary Ann Pentz and Chaoyang Li; 8. Intervention effects on adult drug use and critical influence on development of problem behavior Anthony Biglan and Keith Smolkowski; Part IV. Methodological Issues and Approaches: Advantages and Limitations of Alternate Methods: 9. Log linear sequence analysis: gender and racial/ethnic differences in drug-use progression Kazuo Yamaguchi and Denise B. Kandel; 10. Cigarette use and drug use progression: a growth trajectory and lagged effect hypothesis Peter M. Bentler, Michael D. Newcomb and Marc A. Zimmerman; 11. Using latent transition analysis to examine the gateway hypothesis Linda Collins; 12. Stages of drug progression: a comparison of methods, concepts and operationalizations Kazuo Yamaguchi; Part V. Animal Models and Biological Professes: Implications for Drug Progression: 13. The value of animal models to examine the gateway hypothesis Neil E. Grunberg and Martha M. Faraday; 14. Sensitization as a process underlying the progression of drug use via gateway drugs Susan Schenk; 15. The neurobiology of drug addiction George Koob; Part VI. Conclusion: 16. The gateway hypothesis revisited Denise B. Kandel and Richard Jessor.

Denise B. Kandel, Erich Labouvie, Helene R. White, David Hawkins, Karl G. Hill, Jie Guo, Sara R. Battin-Pearson, Kazuo Yamaguchi, Andrew Golub, Bruce D. Johnson, Gilbert Botvin, Kenneth Griffin, Lawrence Scheier, Mary Ann Pentz, Chaoyang Li, Anthony Biglan, Keith Smolkowski, Peter M. Bentler, Michael D. Newcomb, Marc A. Zimmerman, Linda Collins, Neil E. Grunberg, Martha M. Faraday, Susan Schenk, George Koob, Richard Jessor

UroToday.com – Majority of Pelvic Pain Patients Have More Than One Pain Generating Diagnosis

Chronic pelvic pain afflicts up to 10% of women and results in billions of dollars in direct and indirect costs. Fenton and colleagues from an Akron, Ohio Pain Center determined the frequency and distribution of multiple pain-generating diagnoses in their chronic pelvic pain center and also explored the relationship to previous abuse and drug-seeking behavior.

One hundred seventy-five consecutive patients were evaluated and included in this study. Seventy-seven percent had gynecologic pain, including 35% of the total population diagnosed with interstitial cystitis. Forty-five percent had myalgia and only 5% had vulvodynia. Fully 55% of the patients had a history of abuse. The more diagnoses the patients had, the higher the likelihood of abuse. Ninety percent of the BPS/IC patients carried another diagnosis as well, and 32% had 3 more diagnoses.

Patients with multiple pain diagnoses were similar to those with a history of abuse in that they had higher irritative bowel and bladder scores along with more regions of their body generating pain in addition to their pelvic pain. They did not have higher pain scores or a longer duration of pain. Patients with a history of abuse did not complain of higher levels of pain in any category, however, they did have more irritative voiding and bowel symptoms and noted pain in more areas of their bodies, even when controlled for multiple diagnoses or drug seeking.

The type of abuse was not further spelled out in this paper, and the distribution of diagnoses was undoubtedly skewed by the inherent specialty of the center, as the authors acknowledge. The study is interesting as a 30,000 foot overview, and indicates the need for more focused, stringent, data and hypothesis driven studies in the future.

Reported by UroToday.com Contributing Editor Philip M. Hanno, MD, MPH Professor of Urology Division of Urology, Department of Surgery Hospital of the University of Pennsylvania Medical Director Department of Clinical Effectiveness and Quality Improvement University of Pennsylvania Health System Philadelphia, PA

Most people occasionally worry about germs, strange noises in the night, or whether they forgot to turn off the oven before leaving on vacation. But for as many as 5 million Americans with obsessive-compulsive disorder (OCD), such anxieties are constant and can almost literally take over their lives.

Now two expert clinical psychologists at the University of North Carolina at Chapel Hill will, for the first time, use cognitive-behavioral therapy (CBT) to treat couples in which one partner has OCD. The therapy has been effective in treating individuals who have OCD, and in treating couples where one partner suffers from another health problem. This is the first time the therapy will be used in couples involving a partner with OCD.

Jonathan Abramowitz, Ph.D., associate professor and associate chair of the psychology department in UNC’s College of Arts and Sciences, who is also director of UNC’s Anxiety Disorders Clinic, and Donald Baucom, Ph.D., professor of psychology and director of UNC’s Couples Therapy Clinic, will provide treatment for about 20 couples as part of a new study funded by the Obsessive Compulsive Foundation. The foundation, an international non-profit educational organization, supports research on the causes and treatment of OCD. Abramowitz is also a research associate professor and Baucom is a research professor in the UNC School of Medicine’s psychiatry department.

Participating couples will receive 16 free therapy sessions and follow-up evaluations and will be paid $80 at the end of the study.

Obsessive-compulsive disorder is a psychiatric condition defined by recurrent, unwelcome thoughts (obsessions) and repetitive behaviors (compulsions) that the sufferer feels driven to perform. Persons with OCD are anxious about germs, mistakes, numbers, or obsessive thoughts, and have problems with compulsive checking, washing, asking for reassurance or repetitive rituals.

People with OCD often recognize their obsessions and compulsions are irrational or excessive, but without treatment, they have little or no control over them. Abramowitz, an expert on OCD and a range of anxiety disorders, has used cognitive-behavioral therapy to successfully treat OCD patients individually.

“This therapy involves helping patients learn strategies to reduce their obsessional fears and compulsive behaviors,” he said. Over time, many patients learn that they do not need to perform these rituals to stay safe.

However, coping with OCD can be complicated by a relationship, Abramowitz said.

Stress makes OCD worse. If individuals suffer alone, they worry about being late to work because they spent too much time checking the door lock, or fret about what others would say if they knew they washed your hands incessantly. But for those in a relationship, OCD can lead to stress and arguments between sufferers and their partners, which makes OCD even worse. “It’s a vicious cycle,” Abramowitz said.

Another complication is how the non-OCD partner responds to the compulsive behavior. Even spouses with the best intentions may make matters worse by over compensating for their OCD partner’s fears and rituals.

In the UNC study, trained therapists under the supervision of Abramowitz and Baucom will work with both partners in each couple.

“First we will find out about the OCD symptoms and how the couple has been managing with these problems,” Abramowitz said. “Then we will help the couple learn to work together to address the OCD patient’s obsessions and rituals and assume a healthier relationship in which their interactions do not make OCD worse.”

Study participants will be given “homework” between sessions. They will receive specific help with the OCD symptoms as well as counseling to enhance their overall relationship.

“The hope is that when both partners learn the CBT techniques, the partner without the disorder can be more helpful in encouraging the OCD mate to work through fears realistically,” Abramowitz said. “This would be good for the OCD sufferers and their spouses.”

One in 40 adults and one in 200 children suffer from OCD at some point in their lives, according to the Obsessive Compulsive Foundation.

In addition to engaging in studies, the Anxiety Disorder Clinic and the Couples Therapy Clinic along with other clinics operated by UNC’s psychology department provide low-cost therapy services to the public on a sliding-fee scale. Medical News Today News Article

Restrictions on alcohol have led to the increased use of marijuana among a remote Aboriginal community according to a study in the Australian Journal of Rural Health published by Wiley -Blackwell.

The study entitled “Lukumbat Marawana: A Changing Pattern of Drug Use by Youth in a Remote Aboriginal Community” finds that the prohibition of alcohol and petrol has lead to rise of marijuana use.

In addition, the study highlights the importance of looking at Indigenous substance misuse in the total context of Indigenous poverty, poor health and lack of opportunities.

Lead authors, Drs. Kate Senior and Richard Chenhall, from the Menzies School of Health Research in Darwin, say, “While banning alcohol in Indigenous communities is successful in reducing harm caused by alcohol abuse, it must be done in full consultation with the communities.”

National statistics indicate that marijuana use is highly prevalent in Australia with at least 11% of the urban non-Indigenous population using the drug. This number doubles to 22% among the Indigenous people. Current evidence suggests that rates of marijuana use may be much higher in remote Indigenous communities throughout the Northern Territory

The prohibition of alcohol within the remote Aboriginal community without any attendant efforts to address underlying social causes has created a new set of problems. The existing marijuana market has grown and its use has extended beyond youths to include adults.

Drs. Senior and Chenhall add, “Efforts to control licit substances, such as alcohol, should address the dynamics of alcohol and drug use in totality, as well as interventions that are able to contend with the underlying social determinants of Indigenous health.”

Everyone has known for decades that smoking causes cancer, but until now no one really understood how cigarette smoke causes healthy lung cells to become cancerous. Researchers from the University of California, Davis, show that hydrogen peroxide in cigarette smoke causes lung cancer. This finding may help the tobacco industry develop “safer” cigarettes by eliminating such substances in the smoke, while giving medical researchers a new avenue to developing lung cancer treatments.

Tzipora Goldkorn, senior author of the report said, “With the five year survival rate for people with lung cancer at a dismally low 15.5 percent, we hope this study will provide better insight into the identification of new therapeutic targets.”

In this study researchers exposed different sets of human lung cells to cigarette smoke and hydrogen peroxide and then incubated the cells for one to two days. These cells, along with unexposed airway cells, were assessed for signs of cancer development. The cells exposed to cigarettes smoke and the cells exposed to hydrogen peroxide showed the same molecular signatures of cancer development, while the unexposed cells did not.

Gerald Weissmann, MD, Editor-in-Chief of The FASEB Journal said, “Studies like this will help in the fight against tobacco related death and disease. These experiments not only pin-point new molecular targets for cancer treatment, but also identify culprits in cigarette smoke which eventually leads to cancer.” Medical News Today News Article

A study by the University of Minnesota School of Public Health and the University of Florida suggests that ‘tweens’ should receive alcohol prevention programs prior to sixth grade, when nearly one in six children are already alcohol users.

The study found that adolescents who already use alcohol are less receptive to prevention programs aimed at all students. Intervening at earlier ages, specifically between third and fifth grade, would allow for truly universal anti-alcohol messages that would also provide support for high-risk students.

“Children who use alcohol in sixth grade respond differently to messages about alcohol use than those have not used alcohol,” said Keryn Pasch, M.P.H., Ph.D., University of Minnesota School of Public Health and first author of the study. “By sixth grade it’s too late; we’ll miss many of the at-risk kids.”

The study, published in the journal Health Education and Behavior, compared sixth-graders who had used alcohol in the past year to those who had not, in a multi-ethnic, urban sample of more than 4,000 students in 61 Chicago schools. Among this sample, 17 percent had used alcohol within the past year.

The study found that sixth-grade users of alcohol were significantly different from the non-users on almost all risk factors examined. For example, users were more likely to be male, engage in violent or delinquent behavior, and have friends who used alcohol.

Factors such as lacking the confidence to refuse alcohol and failing to perceive and value the negative consequences of alcohol use are critical in at-risk children. “These are important to note because they are amenable to intervention,” Pasch said.

Researchers suggest a prevention program prior to sixth grade in which parent involvement is central. Students should receive developmentally-appropriate messages that correct inaccurate perceptions that ‘drinking is normal’ and that provide tweens with the skills to refuse alcohol. In addition, interventions should include parental involvement in order to help create opportunities for increased parent-child communication and provide parents with the skills to increase monitoring.

“Parents and the general public don’t realize how early alcohol use starts,” Pasch said. “However, in early intervention, parental involvement is a key factor in delaying alcohol use.”

Medical News Today News Article

Drug treatments for depression can take many weeks for the beneficial effects to emerge. The excruciating and disabling nature of depression highlights the urgency of developing treatments that act more rapidly. Ketamine, a drug used in general medicine as an anesthetic, has recently been shown to produce improvements in depressed patients within hours of administration. A new study being published in the February 15th issue of Biological Psychiatry provides some new insight into the mechanisms by which ketamine exerts its effects.

Ketamine is classified as an N-methyl d-aspartate (NMDA) glutamate receptor antagonist. Maeng and colleagues now provide new evidence that these antidepressant effects of NMDA receptor antagonists are mediated by their ability to increase the stimulation of a-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) glutamate receptors. In other words, their findings indicate that the antidepressant-like effects of drugs like ketamine are dependent on AMPA receptor stimulation. This suggests that drugs that enhance AMPA receptor function might have rapid antidepressant properties.

Dr. Husseini Manji, corresponding author on this paper and a Deputy Editor of Biological Psychiatry, explains that “by aiming new medications at more direct molecular targets, such as NMDA or AMPA, we may be able to bypass some of the steps through which current antidepressants indirectly exert their effects a roundabout route that accounts for the long time it takes for patients to begin feeling better with the conventional medications.” He adds, “Today’s antidepressant medications eventually end up doing the same thing, but they go about it the long way around, with a lot of biochemical steps that take time. Now we’ve shown what the key targets are and that we can get at them rapidly.”

This study is especially important because even though this important antidepressant effect has been found in ketamine, its use also has significant drawbacks. According to John H. Krystal, M.D., Editor of Biological Psychiatry and affiliated with both Yale University School of Medicine and the VA Connecticut Healthcare System, “the only NMDA receptor antagonist found to be effective so far, ketamine, produces transient changes in perception and impairments in cognition.” It is also in the same class of drugs as PCP (phencyclidine) and can cause hallucinations, among other side effects. Dr. Krystal notes that “it is possible that drugs that directly enhance the activity of AMPA glutamate receptors, the AMPAkines, would have antidepressant effects similar to ketamine, without the unwanted side effects.” Exploring the antidepressant effects of the AMPAkines will now be an important target for researchers.

Medical News Today News Article