Visual Cues and Addiction

Do smoking scenes in movies make smokers want to light up?

Smokers and former smokers will understand what I mean when I say that an addiction to smoking is like a pilot light that is always lit, always ready to whoosh into full flame with the application of a few milligrams of nicotine. And they will also understand that feeling, like a bolt sliding home, of instant identification that comes from seeing someone else smoking. Especially if you are not smoking, but wish to be.

It makes sense that a smoker or former smoker who sees someone smoking might find that image to be a trigger for nicotine craving. But we have to ask whether smokers trying to quit are really endangering their newfound abstinence simply by viewing “smoking content” on TV or in the movies. It seems a bit too prudish to be true. Yet, logic would seem to suggest that some sort of behavioral effect might be expected when a smoker in withdrawal sees an image of someone smoking.  Does, say, viewing scenes of smoking in a movie produce changes in brain function robust enough to trigger relapse in the absence of any other direct cues? Are environmental cues of this nature more dangerous to newly abstinent smokers than we thought?

“Our findings support prior studies that show smokers who exit a movie that had images of smoking are more likely to crave a cigarette, compared with ones who watched a movie without them,” said Dylan Wagner of Dartmouth College, in a Society for Neuroscience Press Release. “More work is needed to show whether brain activity in response to movie smoking predicts relapse for a smoker trying to quit.”

In a small study involving 17 smokers and 17 non-smokers, scientists at Dartmouth College set out to determine what differences might show up in a functional magnetic resonance imaging (fMRI) scan of smokers and non-smokers while they watched 30 minutes of a movie with several smoking scenes. The subjects were not told that the experiment was about smoking. But when they viewed smoking scenes, the brains of smokers showed increased activity in a portion of the parietal lobe of the brain called the intraparietal sulcus. The study was published in the January 19 issue of the Journal of Neuroscience.

What does this brain region do? As it happens, the neurons in the intraparietal sulcus encode information about the position and geometrical properties of objects. This part of the brain coordinates eye movement data and reaching movements.  Using a mouse or a joystick is a good example of an activity that involves the intraparietal sulcus.

The intraparietal sulcus, or IPS, has other functions, but primarily it serves, in the words of one study, as an interface “between the perceptive and motor systems for controlling arm and eye movements in space.”  Apparently, the habitual hand gestures used in lighting and smoking a cigarette, when viewed in a movie or commercial, triggered impulses from that part charged with controlling the routine gestural aspects of smoking--if the viewer were actually smoking.

Other studies point to additional aspects of this event-related change in fMRI scans. Writing in the Journal of Neuroscience in 2006, Hamilton and Grafton offer evidence that the IPS is also “uniquely sensitive to the goals of other people’s hand actions.” The intraparietal sulcus seems to “know” what those hand gestures mean, in a sense. Macaques in the lab were used to demonstrate that “cells in macaque IPL were show to respond selectively to both the performance and observation of an action within a sequence leading to a specific goal and not to the same action when it was part of a sequence achieving a different goal.”

This was a strong suggestion that “the IPS is not just a relay but has a central role in representing and interpreting the goals of observed hand actions.”

Perhaps, then, the idea that strong cues can be produced by images and associations is not so far-fetched. It is, for that matter, the founding theory upon which the modern advertising industry has been built, and while the argument over advertising’s effectiveness is never-ending, cigarette scenes in films might have to be considered a form of indirect advertising beamed directly to the parietal lobe of smokers (and perhaps former smokers as well.)

Hamilton, A. (2006). Goal Representation in Human Anterior Intraparietal Sulcus Journal of Neuroscience, 26 (4), 1133-1137 DOI: 10.1523/JNEUROSCI.4551-05.2006

Graphics Credit: http://aslittleaspossible.blogspot.com/

Update on Smoking Bans Around the World

The noose tightens.

Smoking bans are everywhere. But what does the global picture look like as 2011 gets underway? Herewith, a brief rundown of the smoking situation in assorted countries, courtesy of an analysis late last year by BBC News.

-- Canada. In a nation known as one of the toughest of all when it comes to regulating cigarettes, the Canadian Medical Association Journal says the strict laws have been responsible for “cutting hospital admissions for heart and respiratory problems by about a third.”

-- China. In contrast, 2010 gave observers little reason to think that the Chinese government was actually going to enforce the promised national ban on smoking in public places. Enforcement varied from city to city but in general remained vague at best. Only about 25 % of the adult population believes that smoking is linked to cancer. “The country has an estimated 350 million smokers. For every three cigarettes lit worldwide, one is smoked in China,” according to BBC News.

-- Germany. The smoke-free movement hit some snags in Germany, where a ban on smoking in pubs and restaurants in 2008 has been fiercely resisted in some quarters. Tavern owners complain of lost income, and the bans are also disliked “because of an earlier crackdown on smoking initiated by Adolf Hitler’s Nazi regime,” says BBC News. Nonetheless, cigarettes were banned from Munich’s Oktoberfest for the first time in history.

-- France. Curiously, in a nation that was expected to rise up as one against workplace smoking bans, “correspondents say attitudes to smoking have changed dramatically in France since the 2007 ban, and any fears that people would generally ignore the laws have proved false.”

-- United Kingdom. Smoking is banned almost everywhere—“nearly all enclosed public spaces”—in England, Scotland, Ireland and Wales. This year, England may become the first nation to sell cigarettes in plain brown wrappers—a move government officials hope will make the packages less attractive to younger smokers.

-- Iran. Back in 2003, Iran banned smoking in public buildings. According to the BBC, the measures have had “little effect. However, in July 2010 smokers were banned from taking high-ranking jobs in the Iranian government, the news agency ILNA reported.”

-- Russia. The heavy-smoking Russians continue to astound: “A 2009 survey by the World Health Organization found that Russia has 43.9 million smokers—about 40% of the population.” About 60% of Russian men smoke. 500,000 people die of smoking-related illness each year. The Russian government is considering a blanket no-smoking policy for enclosed spaces—starting in 2015.

-- Uruguay. The host of a recent international summit on tobacco control strategies, Uruguay has adopted some of the toughest anti-smoking laws in the world—so tough that the government was forced to back down on some of its sweeping new restrictions due to tobacco industry pressure.

-- Australia. Starting last September, there was no smoking “in cars carrying children, on sections of beaches, and within 10m (32ft) of playground equipment.” Australia also bans smoking in public workplaces, and plans to follow England’s lead in forcing tobacco companies to use plain wrappers for cigarette packages.

-- United States. California, a state that almost managed to pass a proposition legalizing marijuana, has the strictest and most extensive set of anti-tobacco laws on the planet. Smoking is banned not just within public buildings, but also within 20 feet of public buildings, and on all state beaches.

Graphics Credit: http://www.nicotineedge.com/

Marijuana and Testicular Cancer

NIDA touts controversial 2009 study.

After 50 years of rumor, study, and argument in the research community, the National Institute on Drug Abuse (NIDA) has come out squarely behind the assertion that marijuana use in men “may increase their risk for developing testicular cancer.”

But a problem exists. The evidence just isn’t that good. Especially if you base the conclusion on a single small study, as NIDA is apparently doing.

Writing in NIDA Notes for December, 2010, Lori Whitten highlights a study of 369 men from the Seattle area with testicular cancer, and a control group of 979 disease-free men. “The researchers found that the odds of having testicular cancer were 70 percent higher among men who reported current marijuana use compared with nonusers…. They also found that the odds for testicular cancer among men who used marijuana at least weekly were twice that of nonusers.”

The hypothesis supporting this statistical correlation is not terribly robust: Testicular cancer has doubled in the past 50 years in the U.S. So has the percentage of the population that smokes pot. And since cannabinoid receptors are found on the cell membranes of the testes, and chronic marijuana use is associated with decreased testosterone plasma levels and reduced spermatogenesis, marijuana smoking must somehow interfere with the growth of germ cells in the testes. The result: cancer.

But wait, there’s more. Whether or not this contention can be considered true and proven remains quite arguable, but the study does appear to show a statistical association between marijuana use and one particular form of the disease. Marijuana smoking was strongly associated with only one form of testicular cancer, called nonseminomas, a fast growing type representing 40% of all testicular germ cell tumors (TGCT). The other type—seminomas—accounts for the other 60%.

Dr. Sudhansu Dey, a NIDA-funded researcher involved in the study, published in Cancer, told NIDA Notes that the association between marijuana smoking and nonseminomas, but not seminomas, is “difficult to explain.”

Here’s one possibility: Testicular cancer is too rare, and the study in question too small, to be anything but suggestive. It does not show a direct linkage between testicular cancer and pot smoking, and the authors do not claim that it does. In fact, they point to several limitations of their own study. The researchers were only able to directly interview a little more than half of the eligible cases and controls. And the study relied on self-report questionnaires, which, in the case of an illegal drug like marijuana, can skew the results. For example, “patients with cancer may be expected to more accurately admit to the use of an illegal substance than individuals in a control group.”

Specifically, the report states that “the incidence of seminoma from 1973 to 1998 in the US was 64% compared with an increase of only 24% for nonseminoma…. If the increase in nonseminomas was caused in part by an increase in the use of marijuana, then some other increasing exposures must account for the higher incidence of seminomas over time.” The point, as the researchers acknowledge, is that “none of these explanations likely would be specific to nonseminomas. Indeed, if the association is true, then new avenues of research will be needed to address the specificity of the association to nonseminomas.”

In other words, the argument that pot smoking might increase cases of one particular kind of testicular cancer is not accompanied by an explanation of the biological mechanism by which marijuana would be capable of exerting such effects.  The primary risk factor for testicular cancer seems to be a family history of the disease, followed by abnormal development of the testicles or undescended testes.

“If these interesting findings are replicated in a large, national representative group of participants,” Dr. Vishnudutt Purohit of NIDA’s Division of Basic Neuroscience and Behavioral Research told NIDA Notes, “then future research should delve into the molecular mechanism underlying the association.”

At present, that is a very big “if.”

Daling, J., Doody, D., Sun, X., Trabert, B., Weiss, N., Chen, C., Biggs, M., Starr, J., Dey, S., & Schwartz, S. (2009). Association of marijuana use and the incidence of testicular germ cell tumors Cancer, 115 (6), 1215-1223 DOI: 10.1002/cncr.24159
Graphics Credit: http://testicularcanceronline.info/

Everybody wants to be Keith Richards

Whereas they might be better off as Patti Smith.

There was a time, not really so long ago, when the growing legion of Rolling Stones fans was divided: Did Keith spell his last name as Richards, with an “s,” or was it just plain Richard?  Many inquiring minds wanted to know, and for some time, the interesting part was that Keith himself seemed unsure of how to end the argument.

As best I can determine, bringing all my powers as an investigative reporter to bear on this weighty matter, Keith lost track of the final “s” at some point during the late sixties, roughly coinciding with his decent into heavy heroin addiction. However, as the eighties began, Keith, newly detoxed, became “Keith Richards” again, the family name to which he has remained faithful ever since.

This incident is not mentioned in Keith Richards’ new autobiography, “Life.” And I relate this story not to suggest that Richards literally forgot how to spell his name during the peak of his several drug addictions—though such things are not outside the bounds of possibility for, say, severely addled speed freaks.  I am, however, suggesting that the Jekyll/Hyde nature of living a life simultaneously in the open and in secret, as an active addict, does exact some form of toll on one’s internal representation of self.

Did the years of the famed guitarist’s most severe addiction coincide with the years of peak quality output from the Rolling Stones? They did. The same can be said of Charlie Parker, Miles Davis, Hendrix, and on through the roster of illustrious addicts. Do these same addictive years also coincide with a period during which an abnormal number of people around Keith Richards suffered and died? They do. And this doesn’t count the number of people who were mistreated, ignored, inconvenienced, and otherwise dealt with abominably in the course of coping with a key band member’s destructive behaviors when addicted. 

I knew a friend of a friend who almost died partying with Keith.  After a night of cocaine—only the best, pharmaceutical stuff, as Keith is at pains to remind us throughout the course of the book—they took my guy to the hospital in an ambulance, after he suffered some sort of coronary meltdown. This incident is not mentioned in “Life.” Too many similar nights with similar friends to recount them all.

In the end, however, we must allow a certain amount of space to exist between the artist and the art. As for Keith, I’m a lifelong fan. His book is by turns funny, thoughtful, barbed, and observant. It is a book about a man with addictions, but it is not a book about addiction.  In Keith’s opinion, the drug problem is a qualitative matter; a result of Thunderbird, Ripple, and bad acid.  Here, in one passage, are all the contradictions writ large:

I did a couple of cleanups with Gram Parsons at this time—both unsuccessful. I’ve been through more cold turkeys than there are freezers. I took the fucking hell week as a matter of course. I took it as being a part of what I was into. But cold turkey, once is enough, and it should be, quite honestly. At the same time I felt totally invincible. And also I was a bit antsy about people telling me what I could put in my body (p. 284).

In the end, this is how we want Keith Richards to be: smart, arrogant, unruly, piratical.  Is he, as so many say, lucky to be alive? I don’t know. I have no idea what that means. Some people get addicted to heavy drugs and die, and some don’t. If you’re convinced you are one of the lucky ones, then I hope you’re right.

****

Meanwhile, in New York City, a tough little unknown artist named Patti Smith was busily scissoring photos of Keith Richards out of magazines, ultimately cutting her hair and wearing clothes that made her look, as much as possible, just like her idol.

Patti’s Smith’s memoir, “Just Kids,” which won a National Book Award last year, doesn’t dwell at length on drugs, either. But we get the drift of Patti’s thinking easily enough. Max’s Kansas City, the famed punk venue, “was as darkly glamorous as one could wish for. But running through the primary artery, the thing that ultimately accelerated their world and then took them down, was speed. Amphetamine magnified their paranoia, robbed some of their innate powers, drained their confidence, and ravaged their beauty.” (p. 117).

Earlier, staying in a hotel for junkies with Robert Mapplethorpe, Patti strikes up a conversation with an old addict in the next room: “He told me the stories of some of his neighbors, room by room, and what they had sacrificed for alcohol and drugs. Never had I seen so much collective misery and lost hopes, forlorn souls who had fouled their lives. He seemed to preside over them all, sweetly mourning his own failed career, dancing through the halls with his length of pale chiffon.”

Alcohol at the Movies

More booze scenes in European flicks.

Films popular in Europe feature more drinking episodes per movie than their equally popular American counterparts, according to a report by the European Centre for Monitoring Alcohol Marketing (EUCAM).

The trend toward incorporating name brand alcohol in movie scenes as a form of product placement took off more than a decade ago. In 1999, the U.S. Federal Trade Commission reported that in the two previous years, “eight reporting alcohol companies placed alcoholic products in 233 motion pictures and in one or more episodes of 181 different television series.”

Given this background, it is scarcely surprising that watchdog groups like EUCAM in Europe and the Marin Institute in the U.S. have hammered at this issue for years. The Marin Institute was particularly peeved that Carlsberg beer was all over the “Spider-Man” film franchise, despite that film’s popularity with children and preteens.

EUCAM looked at the amount of “alcohol portrayal” in about 30 popular movies playing in 27 European countries in 2009. Eight of the movies were accessible to all ages, including “The Twilight Saga: New Moon,” “Angels and Demons,” and “The Hangover.”

Overall, 12% of the movies examined by the group contained alcohol portrayals or promotions. Surprisingly, Hollywood movies came out looking pretty good. Seven of the 17 Hollywood movies examined contained no alcohol references at all. “In contrast,” says the report, “all of the European movies depicted alcohol or referred to it in the dialogue.”

The report notes that the “highest number of alcohol portrayals of the Hollywood movies was found in ‘Inglorious Bastards’ (eighteen scenes), (a movie that takes place almost entirely in Europe).” And what about second place, I can hear you asking. That honor went to “The Final Destination 4,” with eleven drinking scenes.

One striking difference noted by the report was “the prevalence of drinking while working” in European movies, compared to Hollywood films. And while the Hollywood movies portrayed what the EUCAM defined as “binge drinking” eight times, the group found fifteen instances of binge drinking in the popular European films. This finding may be the most interesting of all, given the public problems with binge drinking that have been reported in parts of Europe and the UK.

“While the alcohol flowed freely in much of the most popular films of Europe,” the report states, “product placement of alcohol was not used in many productions.” Very view of the European drinking scenes employed recognizable logos or brand names.

Finally, only 1% of intoxications scenes in Hollywood movies showed characters passing out, while “in the European movies, this percentage is eight times higher.”

 -----

Recently, I watched an old episode of TV's "Gunsmoke," in which Doc Adams tries to help Dan the Drunk, finding him a new job and a new set of clothes.

“He’s an awful nice feller,” says Chester, “until he ain’t.”

And Doc responds, “When he gets a sniff of the stuff, he drinks till he drops.” And then Doc offers the following thoughts:

"He’s only got one weakness. It sure is a whopper, but it’s the only one he’s got.  Wouldn’t it be something if you could cut it out of him, or patch it up, or something? Wouldn’t that be real doctorin’, though? Wouldn’t it?”


Picture credit: http://www.collegeotr.com

Top Ten for 2010

Marijuana leads the list.

Most viewed Addiction Inbox 2010 blog posts, ranked by total pageviews:


1. Marijuana and Memory: Do certain strains make you more forgetful?

“Cannabis snobs have been known to argue endlessly about the quality of the highs produced by their favorite varietals: Northern Lights, Hawaiian Haze, White Widow, etc….”

2.  The Bong Water Case Revisited: Minnesota v. Peck.

“Astute readers will recall the Great Bong Water Decision of 2009, in which the Minnesota Supreme Court determined, 4-3, that water used in a water pipe can be considered a ‘drug mixture’….”

3. Cannabis Receptors and the “Runner’s High”--Maybe it isn't endorphins after all.

“What do long-distance running and marijuana smoking have in common? Quite possibly, more than you’d think. A growing body of research suggests that the runner’s high and the cannabis high are more similar than previously imagined….”

4. More Vanishing Cigarettes: Churchill, Bette Davis, Don Draper, and Pecos Bill.

“In my last post, I highlighted some examples of attacks on cultural history represented by cigarette censorship, to wit: a cigarette taken out of the hand of Paul McCartney, and out of the mouths of Jackson Pollock and Burt Reynolds.…”

5. Cocaine Treatment and the Stroop Test: Treatment dropouts do poorly on color/word match.

“It’s commonly used to demonstrate behavioral inhibition, but it’s also a nifty parlor game. It is called the Stroop Test, and it plays off the fact that people are far better at reading words than they are at intentionally ignoring them….”

6. Liking it Vs. Wanting it: The joylessness of drug addiction.

“Hedonism, the pursuit of pleasure for its own sake, is not really the answer to the riddle of drug addiction. The pursuit of pleasure does not explain why so many addicts insist that they abuse drugs in a never-ending attempt to feel normal….”

7. Mephedrone, the New Drug in Town: Bull market for quasi-legal designer highs.

“Most people in the United States have never heard of it. Very few have ever tried it. But if Europe is any kind of leading indicator for synthetic drugs (and it is), then America will shortly have a chance to get acquainted with mephedrone….”

8. Sex, Drugs, and… Sex: Pharmaceuticals and sexual performance.

“The search for aphrodisiacs is an ancient, if not always venerable, human pursuit. Named for Aphrodite, the Greek goddess of love, aphrodisiacs are compounds that have the reputation, real or imagined, of increasing sexual desire, pleasure, and potency….”

9. Meth Babies—Fact or Fiction? Research team finds brain abnormalities.

“When it came to babies born to crack-addicted mothers, the media went overboard, creating a crisis in the form of an epidemic that never quite was. By contrast, when it came to babies born to alcoholic mothers, Fetal Alcohol Syndrome went unrecognized in the science and medical community until 1968….”

10. Marijuana Use Up, Up, Up: NIDA releases annual survey of teen drug use.

“Research compiled from an annual survey of 8th, 10th and 12th graders by the National Institute on Drug Abuse (NIDA) shows that “marijuana use increased among eighth-graders, and daily marijuana use increased significantly among all three grades….”

Graphics Credit: http://www.thoughttheater.com/

Science Books for Christmas

Women and children first.

It’s not my fault that some of the best science books of 2010 were written by women. In fact, I’m just going to say it: All of the best science books of the year were written by women. Here are a few candidates.

--Rebecca Skloot, The Immortal Life of Henrietta Lacks 

Publishers Weekly: “A tale of medical wonders and medical arrogance, racism, poverty and the bond that grows, sometimes painfully, between two very different women—Skloot and Deborah Lacks—sharing an obsession to learn about Deborah's mother, Henrietta, and her magical, immortal cells.”

--Mary Roach, Packing for Mars: The Curious Science of Life in the Void

Publishers Weekly: “Roach (Stiff) once again proves herself the ideal guide to a parallel universe. Despite all the high-tech science that has resulted in space shuttles and moonwalks, the most crippling hurdles of cosmic travel are our most primordial human qualities: eating, going to the bathroom, having sex and bathing, and not dying in reentry.”

--Mia Szalavitz, Born for Love: Why Empathy is Essential and Endangered 

Product Description: “An inside look at the power of empathy: Born for Love is an unprecedented exploration of how and why the brain learns to bond with others—and a stirring call to protect our children from new threats to their capacity to love.”

--Deborah Blum, The Poisoners Handbook: Murder and the Birth of Forensic Medicine in Jazz Age New York

Publishers Weekly: “Pulitzer Prize–winning science journalist Blum (Ghost Hunters) makes chemistry come alive in her enthralling account of two forensic pioneers in early 20th-century New York. Blum follows the often unglamorous but monumentally important careers of Dr. Charles Norris, Manhattan's first trained chief medical examiner, and Alexander Gettler, its first toxicologist.”

--Jennifer Ouellette, The Calculus Diaries: How math can help you lose weight, win in Vegas, and Survive a Zombie Apocalypse

Nature: "In The Calculus Diaries, science writer Jennifer Ouellette makes maths palatable using a mix of humour, anecdote and enticing facts...Using everyday examples, such as petrol mileage and fairground rides, Ouellette makes even complex ideas such as calculus and probability appealing."

--Susan Casey, The Wave: In Pursuit of the Rogues, Freaks and Giants of the Ocean

Bookmarks Magazine: “Part science lesson and part adrenaline rush, The Wave is an intense thrill ride that manages to take a broad look at oversized, potentially devastating waves. The critics praised Casey's eloquent writing and jaw-droppingly vivid descriptions of chasing--or trying desperately to steer clear of--these aquatic behemoths.”

And:

Smithsonian science books for kids.

Graphics Credit: http://www.zoology.ubc.ca/