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The New Criteria for Alcoholism

Alcoholism will now be diagnosed on a spectrum, including mild, moderate, and severe. Historically, doctors divided problematic drinking into two categories, alcohol abuse and alcohol dependence. The new criteria for alcoholism in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), no longer includes abuse and dependence diagnoses, Science Daily reports. Now, there is a single alcohol use disorder diagnosis.

Under the new criteria, new research suggests that a third of adults have an alcohol use disorder, and just 20 percent seek treatment for their disease. Having a single drink per day could put one at risk, depending on family history and behavior.

Diagnosing an alcohol use disorder now involves an 11 item criteria list, according to the article. Mild alcohol use disorder requires having two or three criteria from the list, while a severe diagnosis requires six or more. Worldwide, alcohol use disorders affect more people than any other mental health condition. In the United States, researchers found an alcohol use disorder lifetime prevalence of 29.1 percent – but only 19.8 percent of adults were ever treated.

“Most importantly, this study highlighted the urgency of educating the public and policymakers about AUD [alcohol use disorder] and its treatments, destigmatizing the disorder and encouraging among those who cannot reduce their alcohol consumption on their own, despite substantial harm to themselves and others, to seek treatment,” the study concludes.

The research indicated that the 12-month prevalence of alcohol use disorder under the new DSM-5 criteria was 13.9 percent and the lifetime prevalence was 29.1 percent. The aforementioned percentages equate to approximately 32.6 million and 68.5 million adults.

The findings were published in the journal JAMA Psychiatry.

The Cost of Neonatal Abstinence Syndrome (NAS)

The prescription opioid crisis in America has led to a number of babies being born with what’s known as Neonatal Abstinence Syndrome (NAS). Expectant mothers who expose their fetus to opioids of any kind face the risk of giving birth to a child with NAS. The syndrome is the result of withdrawal from the opioid pain medication.

Treating infants with NAS is complicated and requires trained medical personnel which can be costly. A new report has found that the costs of NAS treatment for babies have increased dramatically, Science Daily Reports.

“At our institution, costs associated with treating infants with NAS are exponentially higher than the costs associated with infants not affected,” write Dr. Kay Roussos-Ross, Assistant Professor of Obstetrics and Gynecology, and colleagues of University of Florida College of Medicine, Gainesville.

The researchers analyzed cost trends for infants with NAS at one university-affiliated hospital between 2008 and 2011. Over the course of the three year study, Dr. Roussos-Ross and coauthors found 160 opioid-exposed newborns:

  • 40 in the first year.
  • 57 in the second year.
  • 63 in the third year.

About 50 to 60 percent of opioid-exposed infants developed symptoms of NAS each year of the study, according to the article. Most of the babies (95) were exposed to “opioid agonist” medications, drugs like methadone and buprenorphine, which are given to pregnant women who have an opioid use disorder. The other 65 babies were exposed to prescription opioids used illicitly by their mothers during the pregnancy.

When compared to healthy infants, the researchers found that the cost of treating babies born with NAS is 15 to 16 times higher. Each year, the total costs for treating NAS increased dramatically, the article reports.

  • About $1.1 million in the first year.
  • $1.5 million in the second year.
  • $1.8 million in the third year.

Healthy babies typically spend one or two days in the hospital post-birth. Whereas, babies born with NAS are kept in the hospital for an average of 23 days. Babies that are exposed to opioids in utero that did not develop NAS stay in the hospital for about five days.

The findings were published in the Journal of Addiction Medicine.

Binge Drinking Has Lasting Effects

The effort to understand the effects drug and alcohol use has on the brain during developmental years continues. When teenage drinking is talked about, the words “binge drinking” often arise, that is, consuming five or more alcoholic beverages (male), or four or more drinks (female), over a 2-hour period.

The practice is quite common among teenagers who are trying to consume as much alcohol as they can – in the limited time they have. Binge drinking has been associated with a number of health problems, including alcohol poisonings and the potential for addictive behaviors to develop.

New research suggests that teens that binge drink may experience changes in the brain that last into adulthood, The Los Angeles Times reports. Researchers found that repeated exposure to alcohol throughout one’s formative years may cause long-lasting changes in the area of the brain responsible for memory and learning.

“In the eyes of the law, once people reach the age of 18, they are considered adult, but the brain continues to mature and refine all the way into the mid-20s,” lead author Mary-Louise Risher of Duke University said in a news release. “It’s important for young people to know that when they drink heavily during this period of development, there could be changes occurring that have a lasting impact on memory and other cognitive functions.”

The brains of teenagers and young adults are still developing, according to researchers, and are uniquely sensitive to levels of alcohol consistent with binge drinking, the article reports. Using rats, the researchers found that those who regularly consumed alcohol while their brain was developing had problems with:

  • Memory
  • Attention
  • Judgment
  • Learning Ability

“It’s quite possible that alcohol disrupts the maturation process, which can affect these cognitive function later on,” said Risher.

The findings appear in Alcoholism: Clinical & Experimental Research.

OxyContin Overdoses Drop – Heroin Overdoses Rise

In the United States, prescription drug overdoses are responsible for taking thousands of lives each year. While efforts to promote abuse-deterrent drugs and the implementation of prescription drug monitoring programs has had some promising results, the drop in prescription drug overdoses and prescribing rates has led to a surge in heroin overdoses, HealthDay reports.

In 2010, the makers of OxyContin released a new version of the drug which incorporated abuse-deterrent properties. New research indicates that in the two years following the drug’s new formulation OxyContin related overdoses dropped 19 percent and prescriptions of the drug decreased 19 percent, according to the article.

“This is the first time in the last two decades that narcotic prescribing had dropped, rather than continued to increase,” said lead researcher Dr. Marc Larochelle, an instructor at Boston University School of Medicine.

“With the pill, you used to be able to crush it up and either snort it or dissolve it and inject it. Now if you try and crush it, it doesn’t turn into a powder — it just kind of balls up, and if you try and dissolve it, it turns into a goo,” Larochelle explained.

Unfortunately, the opioid epidemic exhibits the properties of a hydra, cut off one head only to be faced with another. In the same time period, the researchers found that the rate of heroin overdoses increased 23 percent.

“Reducing supply may have led some people who are abusing these drugs to substitute an illicit narcotic like heroin, and it may partially explain why we have seen an explosion in heroin use across the country,” Larochelle said.

Larochelle points out that simply altering drug formulations will not, in and of itself solve the drug abuse problem.

“But it shows supply could be one part of the issue. Abuse-resistant formulations will not cure people who are addicted to narcotics. It could, however, prevent or slow down the number of new people who become addicted, because many people who use heroin may have started with pills,” he said.

The findings were published in JAMA Internal Medicine.

The Best Approach to Combating Binge Drinking

In England, just as the United States, binge drinking is a major problem among young adults. The act of drinking as much as you can, as fast as you can, can lead to a number of problems and even result in addiction. Combating the practice of binge drinking has proven difficult, with research indicating that campaigns against binge drinking have bore little fruit.

A new research conducted by Royal Holloway, University of London, in conjunction with three other UK universities, has found that official messages about binge drinking are unlikely to work and are often dismissed as irrelevant by young drinkers, Science Daily reports. The findings may be due to the consumption of large quantities of alcohol being part of their sub-cultural social identity, a group driven by the need to subvert rules and norms.

“The insight that heavy drinking can be part of a rule-breaking sub-culture may seem obvious, yet huge sums have been spent in the past on Government anti-drinking advertising campaigns that simply fuel the sense that sensible drinking is boring and conformist, while binge drinking is subversive fun,” said Professor Chris Hackley, from the School of Management at Royal Holloway.

“Government messages that say ‘drink sensibly’ ignore the ways many young people actually enjoy drinking. This research also has implications for other areas of Government health policy, where compulsive and excessive consumption can sometimes be fuelled by a need to defy and subvert official rules.”

What’s more, the research showed that high-price tagged ad campaigns may actually have an adverse effect on people most at risk of drinking to excess, according to the report. In the United Kingdom, alcohol related injuries and deaths cost the National Health Service £3.5 billion a year. Clearly, with the price of excessive alcohol consumption being as high as it is, the need for more effective methods is apparent.

The researchers contend that a more targeted and practical approach to alcohol intervention may be more effective than multi-million pound anti-drinking campaigns.

The findings were published in the Journal of Business Research.

Bipolar Disorder and Marijuana Use

Bipolar disorder, also known as manic-depressive illness, is one of the more common co-occurring disorders that people living with addiction experience. Those in the field of addiction are acutely aware that those with co-occurring disorders are some of the most difficult to treat, due to the fact that both the substance abuse and the co-occurring disorder need to be addressed, if a successful recovery is to be achieved. Failure to properly diagnose and medicate co-occurring disorders accordingly usually results in relapse.

Many living with mental health disorders, such as depression and bipolar disorder, often use illicit drugs to cope with their illness. Unlike prescription psychotropic medications, illicit drugs often exacerbate the mental illness, and often times lead to substance dependence and/ or addiction.

New research has found that those living with bipolar disorder who use marijuana experience increased manic and depressive symptoms, Medical News Today reports. Symptoms including:

  • Shifts in Mood
  • Energy
  • Activity Levels
  • The Ability to Carry Out Day-to-Day Tasks

Researchers involved in the study found that around 2% of the UK population has Bipolar Disorder, and 60% of them have used marijuana at some point in their lives, according to the article. “One theory that is used to explain high levels of drug use is that people use cannabis to self-medicate their symptoms of bipolar disorder,” said lead researcher Dr Elizabeth Tyler of the Spectrum Centre for Mental Health Research at Lancaster University.

“The findings suggest that cannabis is not being used to self-medicate small changes in symptoms within the context of daily life. However, cannabis use itself may be associated with both positive and negative emotional states. We need to find out whether these relationships play out in the longer term as this may have an impact on a person’s course of bipolar disorder.”

The findings were published in PLOS ONE.

NPY: Not Only a Treatment for Alcohol Abuse – but a Marker

The practice of “binge drinking” is a common occurrence among young adults, especially with young men. Drinking as much alcohol as you can, as fast as you can, may be appealing to those trying to catch up with their peers; however, binge drinking can be extremely dangerous – leading to a number of health problems – as well as dependence and addiction.

As a result, researchers have long sought ways to curb binge drinking behaviors using science. At the University of North Carolina (UNC), a team of researchers used “a series of genetic and pharmacological approaches” to identify a protein in the brain called neuropeptide Y (NPY), which suppressed binge drinking behavior in a mouse model, Medical News Today reports.

“Specifically, we found that NPY acted in a part of the brain known as the extended amygdala (or bed nucleus of the stria terminalis) that we know is linked to both stress and reward,” explained study lead author Thomas L. Kash, PhD, assistant professor in the departments of pharmacology and psychology and a member of UNC’s Bowles Center for Alcohol Studies. This antidrinking effect was due to increasing inhibition (the brakes) on a specific population of cells that produce a ‘pro-drinking’ molecule called corticotropin releasing factor (CRF).”

“When we then mimicked the actions of NPY using engineered proteins, we were also able to suppress binge alcohol drinking in mice,” notes Kash.

What’s interesting, in the study the researchers found that the “antidrinking” NPY system may be susceptible to alteration by long-term drinking in multiple species. The researchers’ findings suggest that NPY may not only be a treatment for alcohol abuse – but a marker.

“The identification of where in the brain and how NPY blunts binge drinking, and the observation that the NPY system is compromised during early binge drinking prior to the transition to dependence, are novel and important observations,” study co-author Todd E. Thiele, PhD, professor of psychology at UNC and a member of the Bowles Center for Alcohol Studies.

The findings were published in Nature Neuroscience.

Higher Dose Narcotics Increase Depression Risks

The use of any kind of mind altering substance can have an effect on a person’s mental health, in turn causing a number of complications. One of the more common side effects of drug use is depression. Over the last decade, the United States has seen a dramatic rise in prescription opioid use, which has led to an epidemic. New research suggests that individuals who use higher doses of narcotic painkillers are at increased risk of depression, HealthDay reports.

The study followed 355 patients in Texas, who reported low back pain at an initial doctor’s visit, and at one-year and two-year follow-up visits. Researchers initially concluded that those who used higher doses of opioids to manage their pain were more likely to experience depression, according to the article. However continued research indicated that most of the risk of depression is due to the duration of narcotic painkiller use, not the dose – but, higher doses usually were accompanied by longer durations of use.

“A strong potential explanation of our finding that increasing opioid dose increases risk of depression could be that the patients who increase dose were the longer-using patients,” said lead researcher Jeffrey Scherrer, an associate professor for family and community medicine at Saint Louis University. “This is logical as longer use is associated with tolerance and a need to increase opioids to achieve pain relief.”

Establishing a link between painkillers and depression, as well as what dosage might put patients at higher risk, “may inform prescribing and pain management” by doctors, the article reports.

“We hope to find risk factors such as opioid misuse that could be in the pathway from chronic opioid use to new onset depression,” Scherrer said in a news release. “This would expand the targets for intervention to limit the risk of depression in patients who need long-term opioid therapy.”

The study’s findings were published in the journal Pain.

High-Potency Marijuana and Psychosis

New research suggests the use of high-potency marijuana may be linked to an increased risk of psychosis, Medical News Today reports. The study was conducted by researchers at the institute of Psychiatry, Psychology and Neuroscience at King’s College London in the UK.

Dr. Marta Di Forti and her team observed the effects of high-potency marijuana use among 780 individuals aged 18-65. Between 2005 and 2011, 410 participants reported a first episode of psychosis, according to the article. Psychosis occurs when people experience hallucinations or delusions, often happening in conjunction with particular mental health disorders, such as schizophrenia, bipolar disorder and depression.

The research suggests, according to Dr. Di Forti, that the risk of psychosis among marijuana users is dependent on different factors, like frequency of use and drug potency – factors which should be considered by physicians.

“When a GP or psychiatrist asks if a patient uses cannabis it’s not helpful; it’s like asking whether someone drinks,” says Dr. Di Forti. “As with alcohol, the relevant questions are how often and what type of cannabis. This gives more information about whether the user is at risk of mental health problems; awareness needs to increase for this to happen.”

It was determined that around 24% of psychosis cases could be avoided if people were to stop using this high-potency cannabis, the article reports.

Although, since the study was conducted over a long period of time, the researchers say they did not have data on how much marijuana was used each day, which could present problems.

“However, because we collected information about use over a period of years and not about present use, the reliability of such detailed information would probably have been confounded by recall bias to a greater extent than was the general description of pattern of use that we obtained,” the researchers add.

The findings were published in The Lancet Psychiatry.

Daily Drinking and the Risk of Cirrhosis

The over consumption of alcohol can be detrimental to the human body, having an adverse affect on number of organs. Prolonged and excessive use can ultimately result in the loss of life. One of the most common ailments associated with alcohol use is cirrhosis of the liver, the result of advanced liver disease. New research has found that alcohol drinking patterns significantly influence the risk of cirrhosis and that daily drinking increases the risk, Science Daily reports.

“For the first time, our study points to a risk difference between drinking daily and drinking five or six days a week in the general male population, since earlier studies were conducted on alcohol misusers and patients referred for liver disease and compared daily drinking to ‘binge pattern’ or ‘episodic’ drinking,” observed lead investigator Gro Askgaard, MD, of the Department of Hepatology, Copenhagen University Hospital, Rigshospitalet, and the National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark. “Since the details of alcohol induced liver injury are unknown, we can only speculate that the reason may be that daily alcohol exposure worsens liver damage or inhibits liver regeneration.”

In Europe, where more alcohol is consumed than anywhere in the world, approximately 170,000 people die from alcoholic cirrhosis of the liver every year, according to the article. Researchers set out to analyze the patterns of drinking associated with alcoholic cirrhosis.

Hazard ratios (HRs) for alcoholic cirrhosis were determined by looking at drinking frequency, lifetime alcohol amount, and beverage type among nearly 56,000 participants between 50 and 64 years of age. Of the participants, 257 men developed alcoholic cirrhosis; the researchers found that daily drinking and recent alcohol consumption is the strongest predictor of alcoholic cirrhosis.

“Earlier studies regarding lifetime alcohol consumption and risk of alcoholic cirrhosis reached opposite conclusions, for instance, whether a previous high level of alcohol amount predicted future risk, even after having cut down,” commented Dr. Askgaard. “From a clinical point of view, this is relevant in order to execute evidence-based counselling, and from a public health perspective, it may guide health interventions for the general population.”

“This is a timely contribution about one of the most important, if not the most important risk factor for liver cirrhosis globally, because our overall knowledge about drinking patterns and liver cirrhosis is sparse and in part contradictory,” said noted expert Jürgen Rehm, PhD, Director of the Social and Epidemiological Research Department of the Centre for Addiction and Mental Health, Toronto. “The work of Askgaard and colleagues not only increases our knowledge, but also raises questions for future research. The question of binge drinking patterns and mortality is far from solved, and there may be genetic differences or other covariates not yet discovered, which play a role and could explain the different empirical findings.”

The study, “Alcohol drinking pattern and risk of alcoholic liver cirrhosis: A prospective cohort study,” was published in the Journal of Hepatology.

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