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STARTING YOUNG Insight into

NO WOMAN NO CRY

adolescent addiction comes as new guidelines urge early prevention

THE WOMAN WHO DOESN’T FEEL

FROM SMOKING TO DRINKING Marijuana users are five times more likely to develop an alcohol abuse disorder according to a new study

BMXlife gives opportunities to at-risk youth through BMX bikes PREVENTION ON WHEELS

REDEFINING RECOVERY One Day at a Time takes holistic a approach to overcome addiction

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INSERT 2 StartingYoung Insight into adolescent addiction comes as new guidelines urge early prevention

Treatment providers have known for years that adolescents are more susceptible to drug use and consequently, addiction. But now they might know why. Researchers recently discovered a specific pathway in the brain that makes adolescents more prone to problematic substance use, which could lead to stronger prevention efforts. By studying how cocaine affected the behavior of young and adult mice differently, researchers found that a mechanism in the brain which regulates specific protein production also controls addictive behaviors. By manipulating that mechanism, researchers were able to mitigate cocaine’s addictive effects. “Now we have a bidirectional switch that can turn on and off the cocaine-induced changes in the brain,” says lead researcher Dr. Mauro Costa-Mattioli of the Baylor College of Medicine.

“ The excitement of this study is that now perhaps we have a signalling pathway that could be targeted for the treatment of addiction. ”

- Dr. Mauro Costa-Mattioli, Baylor College of Medicine

One size fits all What’s most exciting about the study is that the pathway does not appear to be specific to cocaine. A second study examining nicotine returned similar results, leading researchers to believe any treatments targeting the pathway would be effective for all substances. “In the case of nicotine, it’s exactly the same thing,” Dr. Costa-Mattioli says. “All the drugs of abuse, they reduce the activity, they hijack or change this mechanism.” Researchers say they’re still interested to see if the mechanism plays a role in the transition from social substance use to more problematic use. But they say simply identifying such a crucial link of the substance use chain could lead to significant prevention methods. “Of course, the excitement of this study is that now perhaps we have a signalling pathway that could be targeted for the treatment of addiction,” Dr. Costa-Mattioli says.

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Total improvement Experts say the benefits of implementing early intervention efforts far outweigh the cost. Although limited data exists, studies show investing just one dollar can produce anywhere from a few dollars to $26 in cost savings down the road. “Thus a well-designed, well- implemented early childhood intervention can dramatically benefit the community and society as well as improve children’s and families’ quality of life,” Dr. Volkow says. But the benefits of early intervention go beyond substance abuse. Experts say many of the risk factors for substance abuse are the same indicators for other social, behavioral and academic problems. They say creating a prevention program to address and reduce the risk of substance abuse will pay big dividends across the board. “Interventions designed to reduce early risk factors show benefits in a wide range of areas,” Dr. Volkow says. “Including improved personal and social functioning, better performance in school, and less involvement with the juvenile justice system or mental health services.” 

“ Early childhood intervention can dramatically benefit the community and society as well as improve children ’ s and families ’ quality of life. ” - Dr. Nora Volkow, NIDA director

First eight years To address adolescent drug use, experts say prevention efforts have to start earlier than most would expect.The National Institute on Drug Abuse (NIDA), the government’s top agency on substance use, recently released new guidelines suggesting prevention education should start in the first eight years of a child’s life. Officials acknowledge that early childhood is not a time period normally associated with drug use. But they say factors with family, school and community environments can shape development of certain emotional and behavioral issues that can manifest in substance abuse problems even decades later. “Central to intervening early is the idea of shifting the balance of risk and protective factors in a way that builds a foundation for optimal social development and resilience,” says NIDA Director Dr. Nora Volkow.

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STUDY METHODOLOGY Studying mice genetically modified to be without the Nav1.7 channel, Wood found that such mice had bodies that dis- played a large increase in certain genes responsible for creating opioid peptides. Opioid peptides occur naturally in the body as the body’s painkiller and have a similar effect as opioids. In making more of the opioid pep- tides, the mice were blocking any feelings of pain, which might be the reason people suffering from CIP also don't feel pain. Wood thought that if he gave mice a medicine that reversed the effect of the opioid peptides, it may reverse the disorder. He gave the mice naloxone—a medication used to reverse opioid overdoses—and it worked. Wood figured the same could be done for humans. “After a decade of rather disap- pointing drug trials, we now have confirmation that Nav1.7 is a key element in human pain,” Woods says. “The secret ingredient turned out to be good old-fashioned opioid peptides, and we have now filed a patent for combining low dose opioids with Nav1.7 blockers. This should replicate the pain- lessness experienced by people with rare mutations, and we have already successfully tested this approach in unmodified mice.” CONGENITAL INSEN- SITIVITY TO PAIN (CIP) is a very rare genetic mu- tation that prevents mes- sages of physical pain from reaching the brain.

Research researcher and his team of researchers studied a 39-year-old woman with CIP. Using a laser beam and a dose of naloxone, Wood helped the woman, who elected to partici- pate anonymously, feel pain for the first time in her life. “Used in combination with Nav1.7 blockers, the dose of opioid needed to prevent pain is very low,” says Wood in an UCL release. “People

Using a test subject with a ge- netic mutation that prevents her from feeling pain, scientists have conducted research that shows promise in creating more effec- tive painkillers—and potentially decreasing the need for addictive opioids. Congenital insensitivity to pain (CIP) is a very rare genetic muta- tion that prevents messages of physical pain from reaching the brain. Sufferers of the disorder, as babies, will chew their lips until they bleed. Toddlers have to deal with more potential for falls, bumps and being hurt by hot or sharp things. Adults are at a high- er risk of dying prematurely. The disorder leaves those afflict- ed without channels known as Nav1.7, which carry sodium to sensory nerves. Understanding this disorder and channels of pain reception and delivery has led re- searchers to study the disorder for ways to block pain in those who don't have the disorder. Research- ers thought they could block pain transporting channels in people without CIP so they can help those with chronic and painful ailments like arthritis. HELPING A WOMAN CRY In a study published by the journal Nature, John Wood, a University College London (UCL) Wolfson Institute for Biomedical

with nonfunctioning Nav1.7 produce low levels of opioids throughout their lives without de- veloping tolerance or experiencing unpleasant side effects.”

As for this work leading to com- plete cessation of pain, Wood tells the New Scientist that some research has found success, but nothing has led to the complete pain loss found in those that are naturally without Nav1.7 channels.

who doesn’t feel the Woman WHAT THE FUTURE HOLDS.... As for people with CIP, Woods says he doesn't know if treatment using nalox- one is an option. Long-term use of naloxone could have side effects. What Woods can say, definitively, is that the mice in the experiment felt as little pain as mice who did not have the Nav1.7 channel naturally. Woods, his team, and the rest of the field are working to fill in the re- search gaps to start answering these questions for humans. “We hope to see our approach tested in human trials by 2017 and

Could help in making better painkillers.

we can then start looking into drug combinations to help the millions of chronic pain patients around the world,” Woods says. Imperial College London professor Kenji Okuse reacted to Wood’s findings to the New Scientist, saying that the research will provide more information to doc- tors about pain.

We hope to see our

“Opioids and Nav1.7 blockers could provide much stronger analgesics, but they will not necessarily be better for patients,” Okuse says. “If we take the combination therapy route, people would have to take opioids throughout the lifetime, which is not a welcome thing.”

approach tested in human trials by 2017 and we can then start looking

into drug combinations to help the millions of chronic pain patients around the world. — John Wood, University College London Wolfson Institute for Biomedical Research researcher

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Prevention On Wheels BMXlife gives opportunities to at-risk youth through BMX bikes “I see the bikes as a means to get through to kids about other initiatives.” - David “Joby” Suender outreach coordinator and assistant to the president at ODAAT

BMXlife is a One Day at a Time (ODAAT) youth initiative that launches this summer to get kids on the streets - in a positive way. In its inaugural season, kids will learn pedestrian and bike safety, as well as the “rules of the road,” says David “Joby” Suender of ODAAT, who started the initiative. Many participants do not have access to bikes at home, so it could be their first time putting foot to pedal on one of 10 new bikes the program provides.

Beyond the riding, Suender hopes to convey bigger messages of pre- vention. “I see the bikes as a means to get through to kids about other initiatives - violence, drugs, healthy living,” he says.

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Philly freestylin’ Once they learn the basics, their sur- roundings provide ample room to progress. Suender says Philadelphia is particularly well-suited for BMX riding in particular, a form that can involve performing tricks on manmade features in the cityscape. “It’s great because of the environment that’s readily available to these kids,” Su- ender says. He goes on to describe the city’s features, historic and contemporary, that provide a wealth of obstacles for BMXers to tack- le. The city has been featured numerous times in skateboard and BMX videos, and a rider need not travel far to find a handrail to grind down, or a concrete ledge to jump off.

Two wheels, endless opportunities For those less inclined to the thrill of street riding, BMXlife covers many alternative aspects of riding. Suender says there are other valuable opportunities that biking can offer. He says having a hobby like biking can keep kids motivated and focused on something other than gangs and street life. The physical activity promotes healthy living, and the bike itself can serve as a sustainable means of transportation. Taking a look at the broader BMX industry, Suender says he will educate kids on filming, editing, photography and the mechanics of bike repair. “Maybe one of the kids won’t be into the riding aspect, but they’ll be into the mechanical side, or the filming and editing,” Suender says. “This will set them up with interests they can pursue down the road.” They are all skills Suender has successfully employed in his own BMX career. He says that BMX riding has enabled him to travel domestically and abroad, with his riding featured in videos, maga- zines and websites. It lends credibility to his message for the kids he works with, that they can do whatever they put their mind to. No matter which direction BMXlife leads its participants, the BMX culture presents opportunities that might not reach the kids through other media. And at the very least, Suender’s leadership sets an example for kids at risk. “I’m trying to provide a male role model and mentorship,” he says, “because a lot of these kids are coming from broken homes and don’t have any other outlets.” “Maybe one of the kids won’t be into the riding aspect, but they’ll be into the mechanical side, or the filming and editing. This will set them up with interests they can pursue down the road.” - David “Joby” Suender

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Marijuana users are five times more likely to develop an alcohol abuse disorder, according to a new study

When it rains it pours. The old idiom may be familiar to many drug users who often find themselves battling more than one addiction. While previous research has shown multiple substance abuse disorders often go hand in hand, a new study suggests simply using marijuana can lead to a much higher risk of developing an alcohol use disorder.

Finding the Link Researchers at Columbia University analyzed data from 27,461 people who had used marijuana at the time of first testing, but had no history of alcohol related disorders. When researchers checked back three years later, they found marijuana users were five times more likely to have developed an alcohol abuse disorder.

Researchers said they were surprised the link wasn’t between marijuana use disorder, but simply marijuana use itself. “I think it’s important for people to be aware that there are certain behaviors that come with specific risks,” says Dr. Renee Goodwin, one of the lead researchers. “It would be particularly useful for youth.” Because youth are at a higher risk of experimenting with both drugs and alcohol, researchers said educating them about the total scope of risk is not only important, but could help curb problematic behaviors. “Preventing or delaying the onset of marijuana use could prevent or delay the onset of alcohol use disorder,” Dr. Goodwin says. “Statistically it should.”

“I think it’s important for people to be aware that there are certain behaviors that come with specific risks.” -Dr. Renee Goodwin

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“Preventing or delaying the onset of marijuana use could prevent or delay the onset of alcohol use disorder.” -Dr. Renee Goodwin

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Uses In Treatment For those already struggling with marijuana or alcohol use disorders, researchers said the knowledge that the two behaviors are linked could help people see the bigger picture of their addiction, and could prove useful in their journey toward recovery. “In some ways it may seem self- evident, but it may not be,” Dr. Goodwin says. “If you’re trying to quit drinking, it’s good to know that quitting marijuana could increase your chance of being successful.”

Zero relationship to mood and anxiety disorders As marijuana use has increased in the U.S., with some states even voting for legalization, some have wondered what the psychological cost will be to users. To investigate the question further, other researchers at Columbia University also conducted a recent study to determine if a link exists between increased marijuana use and psychiatric disorders. Although the results, published in the journal JAMA Psychiatry, mimicked previous research in showing a strong relationship between marijuana use and other substance abuse disorders, the findings in regards to psychiatric disorders were much different. The study showed no relationship between marijuana use and increased instances of mood and anxiety disorders, only substance abuse disorders. But despite the lack of a connection, researchers still cautioned against public policy that could lead to increased marijuana use. “The lack of association between more frequent cannabis use with increased risk of most mood and anxiety disorders does not diminish the important public health significance of the association between cannabis use and increased prevalence and incidence of drug and alcohol use disorders,” the authors wrote. 

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Redefining Recovery One Day at a Time takes a holistic approach to overcome addiction

Recovery can be a tricky word. For some it’s short- hand for overcoming chemical dependence, while others distinguish it from words like “abstinence” or “sobriety.”The word represents what an individ- ual does with a new life — how one uses past expe- riences to overcome hardship and thrive spiritually. One Day at a Time (ODAAT) recognizes that this distinction applies to populations beyond addicts and alcoholics, and aims to serve anyone in need of a fresh start. “When we say ‘recovery,’ we’re not just talking about drugs and alcohol,” says President Mel Wells. “We mean any challenges in life.”The support for addiction recovery is there, Wells says, but it rep- resents just one of ODAAT’s holistic services; they also address homelessness, HIV/ AIDS, poverty, and violence and gang prevention, to name a few. Historically speaking, ODAAT’s primary services give shelter and supportive housing to those in need. They have 60 beds for recovering addicts and alcoholics, a men’s and women’s house, each hold- ing 14 residents, and a 38-bed homeless shelter known as Safe Haven. The men’s and women’s homes work with clients to afford them low-cost, supportive housing; Safe Haven and the drug and alcohol facilities are state- and cityfunded, and do not charge rent.

“When we say ‘recovery,’ we’re not just talking about drugs and alcohol. We mean any challenges in life.” - Mel Wells president of One Day at a Time (ODAAT)

“In a lot of cases, the person who has been through those struggles is going to be more driven in life and more successful.” - Mel Wells president of One Day at a Time (ODAAT)

No one left behind Wells takes pride in ODAAT’s “no one turned away” ethos. He says instead of turning people away, the organization has always made room or given referrals to prospective cli- ents on the spot. ODAAT has reach spanning as far away as London and Cambodia, Wells says. In Philadel- phia, ODAAT reaches up to 56,000 people annually, a figure Wells hopes to increase to 70,000 in the coming years. The city of Philadelphia and state of Pennsylvania have picked up on ODAAT’s efficacy, Wells says, and approved increased funding, allowing ODAAT to reach more and more people every day. Not only does ODAAT welcome everyone, it does it fast. ODAAT has staff on hand at all hours to handle incoming clients who often have nowhere else to go. There’s a narrow time frame in which some- one is ready and willing to receive help, and Wells doesn’t want to miss it. “They might change their mind, or they might not even have the chance to. They might not make it another day,” Wells says, speaking to the fatality of life on the streets and in active addiction.

Learning from each other Clients at ODAAT benefit from its widespread acceptance, and Wells says they gain a rare opportunity to grow from others’ stories. With an open, empathetic ear, clients gain insight to struggles they might not know firsthand. For instance, Wells describes the scenario of a recovering addict getting to know an AIDS patient — the addict might have no idea what a person with AIDS goes through every day to stay well, and vice versa. A new perspective can change a client’s attitude toward recovery. And for someone to survive and prosper through any number of life’s challenges, Wells notes, there is no telling what they are capable of. “In a lot of cases, the person who has been through those struggles and comes out is going to be more driven in life and more successful,” he says.

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