Are You Okay?

A variety of drinking tests: the good, the bad, and the silly.

Here’s a short, no-nonsense questionnaire that uses your weekly drinking habits to produce an at-a-glance comparison of how your intake stacks up against others your age and sex. For example, your result might say: “Only 4% of the adult male population drinks more than you say you drink.” Which is food for thought, at least. Join Together (sponsored by The Partnership at DrugFree.org and Boston University School of Public Health) provides this service.

Here is the Mayo Clinic alcohol use self-assessment test, which says with refreshing frankness: “This assessment can’t diagnose you with an alcohol use or abuse problem, but it can help you evaluate your drinking and understand whether you may benefit from seeking help.” Tends to be a bit stern on the drinks-per-day end of things, but otherwise it’s quite straightforward.

Then there is the venerable Michigan MAST Test, first offered in 1971, and revised regularly every since. It’s showing its age a bit as a clinical tool, but here is a link to the 22-question self-administered version: TEST

Iondesign’s Drink-O-Meter is a whimsical test that makes a sober point: “Why not take our test to calculate the state of your kidneys, wallet, and quantity of alcohol you have consumed over the years?” Why not? Well, maybe because you can’t HANDLE the truth: Test results give an estimate of the total number of drinks you have consumed, an estimate of how much money you’ve spent—and an estimate of the number of Ferraris you could have bought instead.

And finally, we have the amazing and ever-popular CAGE Test, so called for the system of naming and memorizing the questions. The CAGE test takes less than a minute, requires only paper and pencil, and can be graded by test takers themselves. It goes like this:

1. Have you ever felt the need to (C)ut down on your drinking?

2. Have you ever felt (A)nnoyed by someone criticizing your drinking?

3. Have you ever felt (G)uilty about your drinking?

4. Have you ever felt the need for a drink at the beginning of the day—an “(E)ye opener?

People who answer “yes” to two or more of these questions should seriously consider whether they are drinking in an alcoholic or abusive manner. Unfortunately, the CAGE test is considered to be an accurate diagnostic tool primarily in the case of adult white males.

Photo Credit: http://tokyotek.com

A 12 Days of Christmas Blog Meme

Wrapping it up.

From DrugMonkey’s blog: “The rules for this blog meme are quite simple. Post the link and first sentence from the first blog entry for each month of the past year.” (Credit to Janet Stemwedel and John Lynch for the idea.)

Here are the 12 first lines from 2011 here at Addiction Inbox. Click month for full story:

January: 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).

February: The Director of the Office of National Drug Control Policy issued a warning about the new synthetic stimulants now being clandestinely marketed as bath salts or insecticide.

March: The U.S. Drug Enforcement Administration (DEA) exercised its emergency scheduling authority yesterday to outlaw the use of “fake pot” products.

April: In the first published examination of thirdhand smoke pollution and exposure, researchers at San Diego State University discovered that non-smokers who move into homes purchased from smokers encounter significantly elevated nicotine levels in the air and dust of their new homes two months or more after moving in.

May: What would it be like to have written a drug memoir and an autobiography before you turned 30? Would it seem like the end or the beginning? Are there any worlds left to conquer?

June: The song is not about cigarette addiction, but it could be.

July: Readers may remember the dark day of January 1, 2008, when the U.S. set an all-time record: One out of every 100 adults was behind bars. That’s more than 2.3 million people

August: The cost of addiction treatment is a legitimate medical expense, as long as you are talking about drug and alcohol addiction, which the IRS recognizes as a genuine medical disease.

September: The DSM-V, when it debuts it 2012, is set to replace the category of “Substance-Related Disorders” with a new category entitled "Addiction and Related Disorders." 

October: It’s official: The Obama administration has thrown off the gloves, repudiating Attorney General Eric Holder’s vow of two years ago that the federal government was not interested in prosecuting “state-legal” cannabis activity.

November: They first turned up in Europe and the U.K.; those neon-colored foil packets labeled “Spice,” sold in small stores and novelty shops, next to the 2 oz. power drinks and the caffeine pills.

December: After years of tightening regulation and dramatic declines in the number of adult smokers, Big Tobacco is targeting teenagers like never before.

Photo Credit: http://simplemom.net

Heavy Drinking Impairs Serotonin Function More Rapidly in Women

My article on women and alcohol.

There are very real gender differences in the way men and women are affected by alcohol. Here's my summary of the subject in a December 16 article for Scientific American Online:

"Women's Response to Alcohol Suggests Need for Gender-Specific Treatment Programs"

A new study underscores that the physical consequences of alcoholism appear faster and are more severe for women than for men...

Article continues HERE.

A Six-Pack of Prior Posts

Don’t fear the chemistry. 

This isn’t a top 10 list, just a compilation of five previous posts here at Addiction Inbox that have continued to draw reader interest since they were first published. If there is a theme running through this set, it is neurochemistry at its most basic level. Take a look, if any of the subjects interests you. (My most popular post of all, on Marijuana Withdrawal, has turned into a self-help message board. I note it here, but leave it off the list, as it has become a blog of its own for all practical purposes.)
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1) Don’t let anyone tell you that the basic notions involved in neurotransmitter action in the brain are over everyone’s head. This post about serotonin and dopamine basics has always been popular, partly because serotonin and dopamine have gone from obscure abstractions to pop buzzwords. But I think it also shows a growing awareness of brain science and its real-world applications among interested readers.

“…. Addictive drugs have molecules that are the right shape for the amine receptors. Drugs like LSD and Ecstasy target serotonin systems. Serotonin systems control feeding and sleeping behaviors in living creatures from slugs to chimps. Serotonin, also known as 5-HT, occurs in nuts, fruit, and snake venom. It is found in the intestinal walls, large blood vessels, and the central nervous system of most vertebrates. The body normally synthesizes 5-hydroxytryptamine, as serotonin is formally known, from tryptophan in the diet….”

Serotonin and Dopamine: A primer on the molecules of reward
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2) Continuing on the chemistry theme, this post on anandamide, the brain’s own form of internal marijuana, has garnered steady attention since 2008. It may be coincidental, but the post also makes mention of serotonin and dopamine.

“…Several years ago, molecular biologists identified the elusive brain receptor where THC, the active ingredient in marijuana, did its work. Shortly after that discovery, researchers at Hebrew University in Jerusalem identified the body’s own form of THC, which sticks to the same receptors, in pulverized pig brains. They christened the internally manufactured substance “anandamide,” after the Sanskrit ananda, or bliss…”

Anandamide, the Brain’s Own Marijuana: Anxiety and the THC receptor.
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3) Interest in the anti-craving drug Topamax, an anti-seizure medication used to treat alcoholism, remains strong with blog readers, although the drug has not become the universal blockbuster many advocates had hoped.

“…Dr. Bankole Johnson, chairman of Psychiatry and Neurobehavioral Sciences at the University of Virginia, told Bloomberg News that Topamax does everything researchers want to see in a pharmaceutical treatment for alcoholism: “First, it reduces your craving for alcohol; second, it reduces the amount of withdrawal symptoms you get when you start reducing alcohol; and third, it reduces the potential for you to relapse after you go down to a low level of drinking or zero drinking…"

Topamax for Alcoholism: A Closer Look. Epilepsy drug gains ground, draws fire as newest anti-craving pill
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4) One of the most popular posts to date was this examination of neurological questions surrounding marijuana and memory loss. Inquiring minds, uh, forget the question. Oh yeah: Does the strain of dope you smoke determine how forgetful you’ll become?

“…As far as memory goes, THC content didn't seem to matter. It was the percentage of cannabidiol (CBD) that controlled the degree of memory impairment, the authors concluded. "The antagonistic effects of cannabidiol at the CB1 receptor are probably responsible for its profile in smoked cannabis, attenuating the memory-impairing effects of THC. In terms of harm reduction, users should be made aware of the higher risk of memory impairment associated with smoking low-cannabidiol strains of cannabis like 'skunk' and encouraged to use strains containing higher levels of cannabidiol..." 


Marijuana and Memory: Do certain strains make you more forgetful?
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5) Finally, a popular post focusing on the biochemistry of nicotine in e-cigarettes, the new, smokeless nicotine delivery system. Are they safe? The latest in harm reduction strategies, or starter kits for youngsters?

“…You may never have heard of it—but it’s the newest drug in town. It’s called an electronic cigarette, or “e-cigarette.” Electronic cigarettes use batteries to convert liquid nicotine into a fine, heated mist that is absorbed by the lungs. No smoke, but plenty of what makes cigarettes go, if you don’t account for taste—or ashtrays and smoke rings….”

E-Cigarettes and Health: Smokeless nicotine comes under scrutiny.

Photo Credit: http://www.livingim.com/

Nothing Organic About Rodale’s New Book on Addiction

Raw carrots won’t cut it.

How times have changed. You’ve heard of Rodale, the outfit that kicked off organic gardening in America, and publishes Prevention Magazine and Organic Gardening? Founded in 1947, the Rodale Institute’s mandate was to publicize J.I. Rodale’s personal vision of healthy soil and healthy food. So it was with great astonishment that I picked up The Addiction Solution: Unraveling the Mysteries of Addiction Through Cutting-Edge Brain Science, published by Rodale Books, heretofore famous for such perennials best sellers as The Rodale Book of Composting, The Rodale Whole Foods Cookbook, Diabetes Without Drugs, and The Organic Manifesto.

So what is the approach taken in this new paperback about addiction? Herbal treatments for alcoholism? Fresh air and sunshine for meth addiction? No. The “brain science” in the subtitle is really just that. Written by Dr. David Kipper, a Beverly Hills physician, and Steven Whitney, a former addict, the book states that addiction is… er… a brain disease, and not primarily a behavioral issue. It seems that Big Science has gotten its murderous dissecting hands around the Rodale organization at last. In neuroscience, not organic carrots, lies the future of addiction treatment, the book asserts. Is old man Rodale turning over in his grave? It gets worse. The Rodale organization is now saying, through this book, that if you are an addict, you might want to consider taking… more drugs.

Here it is, in a nutshell: “An inherited genetic flaw causes specific imbalances in brain chemistry, that, when impacted by stress, create biochemical ‘wantings,’ or needs, that show themselves as bad feelings, uncharacteristic behaviors, and/or addiction, which is medically treated by a new family of pharmaceutical medications that first regain and then stabilize the biochemical balance. During the rehabilitation of the brain chemistry, the patient enters a personalized recovery program featuring behavioral and other therapies.”

You can argue with certain specifics in that definition—“brain imbalance,” for example, is falling out of favor as a descriptor—but there is no denying that it represents an attempt at a strictly neurophysical definition of the condition.

Traditional addiction treatment, the book argues, hasn’t included any of this. The authors maintain that “traditional 28-day inpatient programs at treatment centers are now largely unnecessary. This is good news, since that kind of treatment costs from $50,000 to $100,000 per month.” [Editor’s note: perhaps in Beverly Hills.]

“In contrast,” the authors write, “the new medical paradigm is grounded in outpatient treatment, making it more affordable, especially with insurance and government benefits that define addiction as a medical disease. Thanks to the Mental Health Parity and Addiction Equity Act of 2008, insurers that offer substance abuse coverage must provide the same lifetime limits on payment as they provide for other medical diseases like diabetes, heart disease, and cancer.”

And what does all this accomplish? “More subtly, the new approach replaces the expectation of failure attached to the old, traditional treatment with a tangible opportunity for success, including raising an addict’s self-esteem.” Away with your old and traditional ways, says this Rodale title. If you are looking for an organic alternative to what is becoming the mainstream view of addiction, you will have to look elsewhere. Perhaps Prevention magazine might have something more in your line.

Graphics Credit: http://metalmother.com/

Is Coumadin the Most Dangerous Drug in America?

Common drug most likely to land seniors in the hospital.

High-risk drugs for seniors aren’t the ones you might think. Take warfarin, trade name Coumadin. Millions of seniors do. For people with certain kinds of heart trouble, or who have had a stroke, Coumadin works against the blood’s tendency to clot, and saves lives. In cases of accidental overdose, however, it causes uncontrolled bleeding, and is the likeliest drug to put people over 65 in the emergency room. To further complicate matters, Warfarin interacts with a number of common medications, such as antibiotics, in ways that alter the blood’s clotting ability.

A team of researchers from the Centers for Disease Control and Prevention (CDC) and Emory University studied almost 100,000 emergency hospitalizations due to adverse drug events between 2007 and 2009. The results, published in the New England Journal of Medicine, showed that nearly two-thirds of such hospitalizations were due to hemorrhages caused by unintentional overdoses, and that warfarin was the leading culprit, accounting for about one third of the admissions and costing “hundreds of millions of dollars annually.” Prescription painkillers and sedatives, generally considered to be a major hazard for seniors, account for a mere fraction of hospital admissions—about 1.2%.

Accidental overdoses of insulin products came in second, followed closely by anti-coagulant drugs like Plavix and aspirin. The study makes clear that the main danger for seniors is hemorrhages and other forms of uncontrolled bleeding. In addition, insulin overdose can cause fainting and seizures, and it is not uncommon for those over 65 to be taking drugs for both diabetes and heart disease at the same time.

Half of those hospitalized for drug emergencies were over the age of 80, according to the study, which says that drug-related hospitalizations can only grow as the population ages. 40% of Americans over the age of 65 take five to nine medications, the study revealed.

Clearly, doctors can cut down on admissions and save money by more closely monitoring medications in older patients. But the sad fact is that physicians don’t do a very good job of keeping track of all the medications older patients may be taking. Michael R. Cohen of the Institute for Safe Medication Practices told the Wall Street Journal that pharmacists needed to step into the information gap: “When you get a prescription filled, you’re handed a patient education sheet that’s a printout from the computer,” he said. “It’s very difficult to read, so it generally ends up in the trash.”

Photo Credit: http://www.doctortipster.com

End of the Line for Joe Camel?

The tobacco industry’s war against plain packaging.

After years of tightening regulation and dramatic declines in the number of adult smokers, Big Tobacco is targeting teenagers like never before. The fact that they intend to do it with aggressive package advertising has run up against plans in the U.S., the U.K., and Australia to force cigarette manufacturers to use plain packages in a neutral color, with no brand logos, more graphic warnings, and the brand name in simple typeface.

In an orchestrated attack on cigarette regulation in the UK, tobacco giant Philip Morris, the world’s largest tobacco company, filed a flurry of Freedom of Information Act requests in September designed to give them access to proprietary academic research on teenage smoking habits….

For more, read my entire article at THE FIX....