Top 50 Smoking Awareness Blogs

Addiction Inbox makes the cut.

Addiction Inbox is pleased to find itself listed among the "Top 50 Smoking Health Awareness Blogs" by the Pharmacy Technician Certification web site.

Here is the description included in the listing:

"An exhaustive, comprehensive, and stimulating catalogue of information pertaining to the science of substance abuse, the Addiction Inbox counts nicotine amongst its list of dangers. Expect to see articles regarding tobacco control alongside psychological studies on the physical, emotional, and mental elements of addiction."

Thanks go to Ashley M. Jones for the listing, and for bringing it to my attention.

The latest numbers on cigarette smoking from the American Heart Association show that 23.5 % of white males are smokers, with female smokers having closed the gap considerably with a smoking rate of 18.8 %.

26.1 % of black men are smokers, compared to 20.1 % of Hispanic males, and 16.8 % of Asian men. For women, blacks smoke at a rate of 18.5 %, followed by Hispanic women at 10.1 %, and non-Hispanic Asians at 4.6 %.

The tragic winners, and thus the losers, of the smoking sweepstakes are Native Americans, who show smoking rates of 35.6 % for men and 29.0 % for women.

Graphics Credit: www.chantixhome.com

addiction drugs smoking nicotine

The Rehab Scandal: Relapse Rates

If 8 out of 10 addicts fail, is it really treatment?

The British drug treatment and recovery community has been squabbling recently over annual figures published by the National Treatment Agency (NTA) showing a marked increase in the number of people in drug treatment programs in Britain.

BBC home editor Mark Easton dug into the data and found that, of 202,000 people in treatment, a total of 7,324 “left the treatment programme drug free last year.” Ergo, “Just 3.6 % of those in treatment were discharged free of illegal drugs. “

Andrew Brown, a writer who covers addiction and substance abuse, cited studies showing relapse rates of 80 % or more, and wrote in the UK Telegraph that residential treatment advocates “can be fervent, and persuasive, in their enthusiasm, especially those individuals for whom rehab represents the turning point in their battle with addiction. But the fact is that the expected outcome from most people who enter a treatment centre remains—relapse.”

In the current issue of Newsweek, science writer Sharon Begley gives us some inadvertent clues. Since most residential treatment therapy revolves around individual and group counseling by psychologists, not M.D.s or prescribing psychiatrists, it is unnerving to discover, in a study highlighted by Begley, that clinical psychologists in general practice do not necessarily use “the interventions for which there is the strongest evidence of efficacy.” In other words, where’s the science?

This is an argument that severely rankles psychologists, naturally enough. But Begley writes that because of rigorous clinical trials, we know, for example, that cognitive behavioral therapy can be effective against depression, OCD, bulimia, and other strongly serotonin-mediated disorders. “Neuroscience,” writes Begley, “has identified the brain mechanisms by which these interventions work, giving them added credibility.”

What, then, do we find being used as therapeutic tools in such situations by psychotherapists in the trenches, including those in addiction treatment facilities? The answer, according to Begley, is likely to be “chaotic meditation therapy, facilitated communication, dolphin-assisted therapy, eye-movement desensitization....”

Begley could have added sacral cranial therapy, electric acupuncture, and a host of other questionable practices now subsumed under the broad rubric of clinical psychology. The point is obvious: With more than a thousand brands of psychotherapy currently being practiced, it is safe to say that the field is rife with conflicting opinions about what works.

The problem is that the addicted person has no way of knowing whether the clinical therapy on offer during treatment is backed up by enough sound scientific evidence to warrant participation.

As long as clinics are showing relapse rates not unlike those shown by alcoholics and other addicts going it alone, patients and those involved in their recovery have every reason to view addiction therapy programs with a critical eye.

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World Mental Health Day

Primary health care vs. mental health care.

Mental health care, including addiction, has traditionally run on a separate but very unequal track, compared to primary health care. Of the more than 450 million people around the world who suffer from a mental disorder, it is estimated that fewer than half receive medical help of any kind. Most developed countries have carved out mental health services as a distinct medical institution—one marked by less funding, reduced options, limited services, and little connection to overall health care needs.

Saturday, September 10, marks the 17th annual World Mental Health Day. Established by the World Federation for Mental Health, the day is commemorated through a variety of events and programs in more than 100 countries. The group calls for sustained advocacy on behalf of quality care for people with mental and emotional health problems all over the world.

The campaign theme for 2009 is “Mental Health in Primary Care,” with a focus on worldwide efforts to shift mental health diagnosis into mainstream healthcare. Primary care is the term used to describe the long-term relationship between an individual and their doctor. A person’s general doctor provides for health needs and coordinates additional doctors and services when needed.

The World Federation for Mental Health notes that “neurological disorders starting in the brain were once seen as a separate matter, not needing any physical monitoring—but in recent years there as been greater recognition of the very important link between good mental health and good overall health.”

The report also states that “those with severe and persistent mental illnesses are often twice as likely to have multiple physical health issues.”

Why is this shift a good idea? According to a study released last year by the World Health Organization (WHO) and the World Organization of Family Doctors, this approach has several advantages: “People can access mental health services closer to their homes, thus keeping families together and maintaining their daily activities.... Mental health care delivered in primary care minimize stigma and discrimination, and remove the risk of human rights violations that occur in psychiatric hospitals.”

In addition, according to the study:

--Most people seek help for mental health problems in primary care settings.

--Mental health problems frequently go untreated in the primary care environment.

--People of color, children, and the elderly are the least likely to receive appropriate care for psychiatric disorders.

--Primary care diagnosis of mental health problems reaches people who cannot or will not undergo specialty mental health care.

Graphics Credit: www.unmultimedia.org

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Banning legal drugs

Fool’s errand or necessary evil?

In the cat-and-mouse game that is the designer drug industry, spinning new variations on old themes is the name of the game. When law enforcement and the courts decree a substance illegal for human use due to abuse potential—like the “date rape” drug GHB, banned several years ago in the U.S. and Britain—underground drug designers go to work on spinning molecular variations on the theme. When they hit on an acceptable “near-beer” equivalent, they can flood the market and reap another tidy illegal round of profits on, for example, GBL, which the body converts to GHB when consumed. That is, until law enforcement catches up with that one, and bans it, and then the cycle repeats itself.

The Analogue Drug Act of 1986 was designed to combat this dilemma in the United States by outlawing drugs “substantially similar” to any drug that is already illegal. However, “chemical experts disagree on whether a chemical is “substantially similar” in structure to another chemical—so much so that Federal Analogue Act litigation often degenerates into a “battle of experts,” which is founded more on opinion than on actual scientific evidence,” writes Gregory Kau in an article for the University of Pennsylvania Law Review. “One survey of Federal Analog Act jurisprudence discovered that courts sometimes considered a chemical’s two-dimensional structure rather than the three-dimensional structure as a factor; that courts sometimes ignored the difference in the number of atoms as a meaningful factor; and that courts even ignored quantitative “similarity analysis” results that pharmaceutical companies use to determine whether a chemical is structurally similar to another.”

Recently, Britain added itself to the list of nations that have banned several so-called “herbal highs,” mostly industrial chemicals or synthetic cannabinoids. In addition to GBL, or gamma-butyrolactone, the ban includes BZP, or benzylpiperazine, sold as a stimulant club drug similar to amphetamine. Both are already illegal in the U.S.

In addition, the British Home Office banned a substance known variously as Spice, Spice Gold, or Spice Diamond, which is sold as a legal herbal alternative to cannabis. The product was banned in Germany and France earlier this year. Over the past two years, tests at a German pharmaceutical company, and assays of Spice products seized by U.S. customs agents have confirmed the presence of several synthetic versions of natural chemicals found in marijuana. These cannabinoids include JWH-018, CP-47,497, and HU-210 in liquid form, which is then sprayed on herbal products. The chemicals in question currently find use only in medical research, and the extent to which they provide a high in the absence of THC is based on anecdotal reports, and varies widely.

GBL, a chemical solvent used as a paint stripper, is sometimes sold as “liquid ecstasy.” The amphetamine alternative BZP is used as a fertilizer and as a veterinary medicine. Both are now classified as Class C drugs like tranquilizers, possession of which can bring a two-year jail sentence.

Spice, or at least the synthetic cannabinoids the products contain, are now listed as Class B drugs, the same as marijuana, bringing with it the possibility of a five-year jail sentence.

In an attempt to gain a leap on underground drug designers, the British government has banned all drugs in the so-called piperazine family that includes BZP. This will likely motivate underground chemists to find a molecular family with similar effects to BZP.

Graphics Credit: www.images.tilllate.com


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Russian Heroin Addiction “Spreads Like Wildfire”

Is defoliating Afghanistan the answer?

Last week, both the New York Times and the Los Angeles Times declared that heroin addiction has reached epidemic proportions in Russia. However, Soviet drug enforcement officials have a plan: They have called on the United States to defoliate Afghanistan.

For years now, Russia has been flooded with cheap opium from Afghanistan, smuggled in through Tajikistan and other countries along Russia’s “virtual borders” in Central Asia. What began as a trickle of addicted Russian soldiers during the Afghan war in the 1980s has reached epidemic proportions, Russian officials maintain.

“It’s a catastrophe for us,” a Moscow drug addiction specialist told the Los Angeles Times in an article by Megan K. Stack. “We were completely unprepared for this turn of events.” The Times article notes that the flood of cheap heroin has largely been met with “widespread public ignorance of the risks and symptoms of addiction, lingering shame and stigma, and muddled government efforts at treatment.”

To cap things off, methadone is illegal in Russia.

The New York Times reported in an article by Ellen Barry that Afghan poppy cultivation had become a diplomatic sore point between Moscow and Washington. “I would call on the United States to use defoliation from the air,” said Viktor P. Ivanov, Russia’s Drug Czar, so to speak. “There are people who support this method in the United States. The debate is going on, which is important.”

Russian authorities estimate that 30,000 young Russians dies each year from drug use, predominately Afghan heroin. Although the nation’s opium crop has shrunk in recent years, “Afghanistan still produces more opium than the worldwide market can absorb,” according to Ellen Barry. The reserve may have grown to 10,000 tons, representing a two-year world supply, according to a recent United Nations report.

Years earlier, officials in the Bush administration had briefly investigated an aerial spraying program in Afghanistan, but backed off amid fears that the move would stoke anti-American anger by depriving farmers of their livelihood and increasing the likelihood that they would join the insurgents. The U.S. undertook a largely ineffective manual eradication campaign, and the Obama administration has thus far focused efforts on interdiction and the cultivation of alternative crops, according to the New York Times report.

Photo Credit: www.stratfor.com

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FDA Bans Flavored Cigarettes

An unintentional boost for cigar sales?

When is a cigar more than just a cigar? When its appearance allows it to circumvent the intent of the Food and Drug Administration’s first ruling related to cigarettes, that’s when.

In its first official ruling since Congress passed legislation giving the agency authority to regulate tobacco (see my earlier post), the FDA banned so-called flavored cigarettes. Cigarette makers can no longer add vanilla, clove, chocolate, or any other fruit or candy flavors to their product. Menthol, for now, is exempt from the ban.

FDA commissioner Margaret Hamburg said that 90 percent of adults who smoke began doing so as children. The president of the Campaign for Tobacco-free Kids agreed, calling flavored cigarettes “starter products” for young smokers in a Dow Jones Newswires report by Jennifer Corbett Dooren.

By law, the agency cannot ban regular cigarettes outright. However, as Gardiner Harris reported in the September 23 New York Times, “the legislation left some details vague. For instance, the agency is required to ban flavored cigarettes, but the law did not clearly define what constituted a cigarette."

Huh? As it turns out, a cigarette is in the mind of the beholder. The FDA maintains that the ban applies to all cigarette-type tobacco products, including those that are “labeled as cigars or as some other product.” A spokesperson for the Campaign for Tobacco-Free Kids agreed: “The FDA demonstrated that they’re serious about enforcing the ban on flavored cigarettes, and serious about preventing tobacco companies from circumventing that ban,” according to the New York Times article.

Not so fast, argued Norman Sharp, president of the Cigar Association of America. Sharp told the Times that the ban clearly did not apply to cigars: “We feel this should go a long way to clearing up any confusion in the marketplace.”

Well, not exactly. An exasperated spokesperson for cigarette maker R.J. Reynolds, also quoted in the article, said: “It’s hard to understand. We need clear and timely guidance so all of us can work together so that we can understand what we need to be doing.”

What about the small brown cigarillos sold by an R.J. Reynolds subsidiary?

“They are not cigarettes,” the spokesperson said.


Photo Credit: http://politics.mync.com/tag/cigarette/

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Kudzu for Alcoholism?

Common vine extract may inhibit drinking.

Score one for traditional Chinese folk medicine. A compound called daidzin, found in kudzu vine, acts like the anti-drinking medication Antabuse. Daidzin interferes with the metabolization of alcohol and causes the well-known flushing and sick feeling associated with Antabuse.

However, Dr. Ivan Diamond of the University of California in San Francisco and Dr. Ting-Kai Li of Duke University Medical Center maintain that a synthetic derivative of the active ingredient in kudzu vine also helps diminish the desire to drink in alcoholic rats. It does so, they believe, by preventing alcohol-induced increases in dopamine in the brain’s pleasure center. This additional finding about daidzin may help prevent relapse in recovering alcoholics by diminishing cravings—something Antabuse does not do.

The study will be published in the November issue of Alcoholism: Clinical and Experimental Research.

Currently, the commonly prescribed medications for alcoholism include disulfiram (Antabuse), naltrexone (Revia and Vivitrol), acamprosate (Campral), topiramate (Topamax), and baclofen (Lioresal).

Harvard researchers Wing Ming Keung and Bert Vallee first discovered the effects of kudzu on drinking. A 2005 paper in Alcoholism: Clinical and Experimental Research, authored by Scott E. Lukas, et. al., reported the results of testing a kudzu extract on a clinical population of “heavy” drinkers. The result: “Kudzu treatment resulted in significant reduction in the number of beers consumed... and a decrease in the volume of each sip.” The earlier researchers, however, did not report any significant effect on the urge to drink.

In their recent research, Diamond and Li believe they have found a synthetic version of daidzin, CVT-1-216, that does effect the desire to drink. According to Diamond, the study found that the drug “prevents the usual increase in drinking (binge drinking) that occurs after five days of abstinence....”

“Extracts of various parts of the kudzu vine have been used in many Chinese herbal medicine formulas and are said to be helpful in treating a variety of maladies,” said Dr. Li, who was formerly the director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). “The findings show promise that CVT-10216 might be better tolerated than Antabuse,” he added.

Dr. Diamond called alcoholism “a medical disorder, not just a problem of will power. Physicians treat medical disorders in order to prevent harm, while not necessarily curing the disease being treated—for example, drug treatment of hypertension, stains for high cholesterol, insulin for diabetes—and the same will become true for treating alcoholism.”

Diamond also agrees that synthetic kudzu extract may prove superior to Antabuse in other ways. “Most believe that disulfiram (Antabuse) would not be approved today as a new drug for alcoholism because of its many toxicities.”

Photo Credit: www.skrewtips.com

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