DakotaTreatmentMag

BORN With It

From Smoking To Drinking Marijuana users are five times more likely to develop an alcohol abuse disorder, according to a new study.

S tudy finds alcohol changes the brain from the very first drink.

Still Effective After all these Years After 80 years, AA Still Works

COPING WITH DISCRIMINATION Discrimination remains largly ignored as a cause of substance abuse

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Still Effective After All These Years After 80 years, AA still works

For those seeking to break free from addiction to drugs and alcohol, one of the most widely used -- and easily accessible -- tools has been the Twelve Steps, first published in 1939 in the book,”Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered from Alcoholism.” Not much has changed since 1939, in what the Twelve Steps require of individuals, in order to regain control of their lives.The process, known to its adherents as “working the steps,” involves taking individual responsibility for one’s actions, admitting that one is powerless to control the addiction, and seeking the help of a higher power in order to heal. The benefits of the Twelve Step method are widely known: acceptance into a fellowship of non-users who regularly attend meetings to discuss their addictions, face their actions, and atone for them through spiritual practice and forgiveness. Although Alcoholics Anonymous and its many offshoots do not conduct or allow others to conduct research into the effectiveness of the methods, the military has produced studies that show individuals who attend meetings are 60% more likely to achieve sobriety than those who do not.

Millions of men and women around the world have used the Twelve Steps to break free from a wide variety of addictions and compulsions. More than 200 self-help organizations around the world have adopted twelve-step principles for help with compulsion for, and/or addiction to, gambling, crime, food, sex, hoarding, debting and over-working, among others.

Where did the Twelve Steps come from? According to an article published by AA co-founder Bill W. in 1953, there were three primary sources of inspiration: the Oxford Groups, Dr. William D. Silkworth of Towns Hospital and the famed psychologist, William James, widely considered the father of modern psychology. The Oxford Groups, an evangelical movement which became popular in the 1920’s and early 30’s, preached concepts like absolute honesty, absolute purity, absolute unselfishness and absolute love. “The Twelve Steps could be considered a personal roadmap for achieving sobriety and serenity.”

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Combining science and spirituality William James’ major contribution to the philosophical underpinnings of AA was his book “Varieties of Religious Experience.” In his book, James provided scientific validation for the concept of spiritual experiences, which he said could transform people and enable them to overcome personal defeat and find recovery. The Twelve Steps could be considered a personal roadmap for achieving sobriety and serenity and living a life of freedom from addiction to alcohol and drugs. Each of the steps is only one sentence in length, but each one contains enough universally applicable wisdom and power to fill a book. While the 12 steps has provided a path to recovery for countless alcoholics, drug addicts and others seeking to break free from addictive or compulsive behavior, they have also sparked controversy and debate over the decades. The major source of controversy is AA’s longstanding emphasis on a belief in God. AA supporters point out that, in the AA context, that means belief in “a higher power,” a belief in something larger than the self.The phrase was coined in the early years of AA.

They also practiced a type of confession, which they called “sharing,” the making of amends for harms done they called “restitution.”They believed in the value of “quiet time,” a form of meditation and seeking of God’s guidance, practiced in both group and individual settings. Dr. Silkworth spent years helping alcoholics dry out at Towns Hospital in New York City. One of his core beliefs, which he often spoke on, was the disease concept of alcoholism -- defined as an obsession of the mind combined with an allergy of the body.

“’Higher power’ doesn’t necessarily mean a deity, and those who use the steps are free to interpret that phrase as they see fit.”

“Higher power” doesn’t necessarily have to mean a deity, and that those who use the steps are free to interpret that phrase as they see fit, based on their personal beliefs.The phrase could be applied to mean the power of the group, or nature. Some AA members around the world who don’t accept faith in a god as a necessary tenet have formed their own agnostic AA groups. More than 90 unofficial, self-described “agnostic AA” groups now meet regularly in the U.S., according to Patheos.com. The debate continues. Some think the 82-year old organization has drifted away from its core principles and become too lenient, Lee Ann Kaskutas, senior scientist at the Public Health Institute’s Alcohol Research Group in Emeryville, Calif., told CharismaNews.com. “Others think it’s too strict, so they want to change AA and make it get with the times.” Newcomers to AA are often advised to “take what you need and leave the rest,” Kaskutas points out.That flexibility allows participants to put together a recovery program that fits their needs. It’s one of the reason AA still works for people, eight decades after its founding. 15

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BORN WITH IT Scientists Discover Possible 'Meth Gene’

Researchers have recently identified a gene that may play a role in meth addiction. New findings by Boston University School of Medicine researchers, published in PLOS Genetics, spotlight a gene called heterogeneous nuclear ribonucleoprotein H1 (Hn- rnph1). The research uncovered a link between this gene and how it effects behavior when stimulants are introduced. This new insight can help scientists understand genetic risk factors for addiction, along with some neuropsychiatric disorders. Also, this new understanding about how Hnrnph1 works could lead to the development of a prescription drug to help treat meth ad- diction, researchers say.

Need To Ident i fy Targets

other findings to improve the treatment of both dopamine- related problems like attention- deficit hyperactivity disorder, schizophrenia, and bipolar disor- der, along with dopaminerelated neurodegenerative disorders like Parkinson’s or Huntington’s diseases. Scientists say the genetic epide- miology of meth use disorders is very complex. Efforts to under- stand the biological processes that increase susceptibility to meth use disorders (i.e., abuse, dependence and psychosis) have uncovered several genetic variants. However, more research needs to be done. Though gene research can led to breakthroughs in treatment, Boston University points out in its news release that genetics alone are not responsible for addiction. Environmental and social factors also play an im- portant role.

The BU scientists discovered that Hnrnph1 “codes” for an RNA protein that regulates how other genes are processed in the brain. To better understand the genetic basis of meth addiction, the next step is to figure out the exact genetic targets of Hnrnph1. “A better understanding of the brain region and cell type-specific binding targets of Hnrnph1 will tell us more about the function of this gene and possibly identify new therapeutic strategies for minimizing risk and treating psycho-stimulant addiction — a disorder for which there is currently no FDA-approved drug,” says study co-author Dr. Camron Bryant in a news release from Boston University.

The study could also lead to

Other factors in addict ion According to the National Institute on Drug Abuse (NIDA), these are some of the environmental factors that come into play with ad- diction: • Friends and people addicts spend time with • Age when a person begins using drugs or alcohol • Neighborhood

“A better understanding

of the brain region and

cell typespecific binding

targets of Hnrnph 1 will

tell us more about the

function of this gene.” — Dr. Camron Bryant, study co-author

• Availability of drugs and alcohol • Presence of mental health issues • Gender

These environmental influences interact with genetic factors to influ- ence an individual’s susceptibility to addiction. While scientists hope to better understand the role genetics plays in addiction to meth and other drugs, much more research needs to be done to solve the puzzle.

Genetics alone are not responsible for addiction. Environmental and social factors also play an important role.

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Discrimination, whether based on race, gender, or sexual orientation, has long been thought to be a contributor to substance abuse. Now a new study has confirmed the relationship between discrimination and addiction, but it’s also brought up many more questions that still need to be answered in order to improve treatment outcomes. Researchers at the University of Iowa recently com- pleted a peer review study in which they looked at 97 previous studies on discrimination and alcohol use. Their goal was to summarize the collective knowl- edge researchers have uncovered throughout the years, and what they found confirmed in more detail what many had previously suspected.

“Generally there is good scientific support, but the evidence is mixed for different groups and for types of discrimination.” - Dr.Paul Gilbert, University of Iowa

overtly racist or sexist to another person. But less research has been done on what are known as mi- cro-aggressions, small everyday occurrences that can rub a person the wrong way. That research is improving, but there are other factors that need to be more fully explored. While studies have looked at historical trauma in the African-American popula- tion, the concept has not been fully investigated with regards to Hispanic and Asian populations. “This notion of historic trauma could be really rel- evant to other groups, but it hasn't received much attention at all,” Dr. Gilbert says. “This is something we should pay attention to.” All of this adds up to the fact that treatment provid- ers may be missing a key piece of the substance abuse puzzle.

The team found that discrimination did indeed lead to an increase in drinking frequency, quantity of alcohol consumed, and in the risk for alcohol use disorders. Researchers say drinking can represent a coping mechanism in response to the stress caused by discrimination, and several studies showed clients acknowledging this direct link themselves. But when looking at specific populations and types of discrimi- nation, the picture becomes less clear. “The story is that generally there is good scientif- ic support, but the evidence is mixed for different groups and for types of discrimination,” says Dr. Paul Gilbert, the study’s lead author. “We don’t real- ly know comparing one type or one level to another.” For example, much research has been done on inter- personal discrimination where someone is

But just because the intricacies of how discrimination affects drink- ing aren’t yet fully understood, that doesn’t mean our current knowledge base can’t be helpful. Dr. Gilbert says simply knowing that experiences with discrimination can drive drinking could in- form the way treatment providers interact with clients, opening new areas of their lives to explore during treatment. “It can serve as sort of an early warning or indicator,” Dr. Gilbert says. “For treatment providers, it’s worth looking at: is there some- thing that may be keeping folks from accessing services or affecting outcomes?”

Dr. Gilbert says treatment providers should continue to address discrimination as part of a holistic approach to recovery. He says it will be up to researchers to fill

in the gaps to find the precise ways that discrimination affects drinking behavior. “We’ve got good evidence on this level of interpersonal discrimination,” Dr. Gilbert says. “We’ve gotten the low-hanging fruit, now it’s time to start working on the stuff that’s a little further up the tree.”

“It can serve as sort of an early warning or indicator.” - Dr. Paul Gilbert, University of Iowa

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INSERT 6 Learning to Drink

Study finds alcohol changes the brain from the very first drink

“ Drugs of abuse basically hijack the normal learning and memory processes. ” - Dr. Dorit Ron University of California - San Francisco

Preventing escalation

The NIAAA-funded study did not establish a relationship between initial use and addiction, or even problematic drinking. But the hope is that further understanding of how alcohol affects the brain initially could lead to better treatment and prevention efforts down the road. “If we can control that step, we may be able to prevent further escalation,” Dr. Ron says. More research is needed to determine which other components of the brain are affected by initial alcohol exposure. Dr. Ron says she believes the changes that occur during first exposure could be reversed with prolonged abstinence from alcohol. But she said the more a person drinks, the harder it is to reverse those changes as the brain forms stronger connections to drinking.

One drink is all it takes. That’s what one research team found when studying how even the first exposure to alcohol can affect a person’s brain. A team from the University of California - San Francisco exposed mice to alcohol and then studied the synapses (connections) in their brains.The team found that even the first drink produced significant changes in the brain’s biological structure, calling the changes a “learning event.” “This is basically the first step,” says Dr. Dorit Ron, one of the chief researchers. “You are basically placing a memory trace.” Dr. Ron says the entire study was based on the idea that “addiction, and not just alcohol addiction, is thought to be a maladaptive form of learning and memory.” In essence, the study showed that first exposure to alcohol primes the brain for further use and lays the foundation for future “learning.” “Drugs of abuse basically hijack the normal learning and memory processes,” Dr. Ron says. “The behavior becomes habit.”

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Predicting behavior

INSERT 6 A new study also suggests that the earlier a person starts drinking, the stronger those connections may become. Researchers recently set out to identify which substance people use first in their lives and found the majority of people try alcohol before any other substance.The team also looked at how a person’s age when they start drinking affects substance use later in life. Researchers say the earlier someone starts drinking, the more likely they are to use more than one illicit substance, and they’re also more likely to develop an addiction. “It’s a very nice predictor for polysubstance use,” says Dr. Adam Barry, the study’s chief author. “The later you delay, the closer you are to 21, the less likely you are to be alcohol dependent or dependent on other substances.”

“ Alcohol consumption among youth doesn’t occur in a vacuum. ” - Dr. Adam Barry, Texas A&M University

Curbing use Researchers acknowledge there’s a difference between a first sip and a first binge drinking event. But they say age at first use of any kind is still a good predictor of behavior later in life. To combat problematic drinking, Dr. Barry says educators need to address all factors of a child’s life, not just the substance itself. In keeping with new guidelines from the National Institute on Drug Abuse, Dr. Barry and his team recommend beginning substance education as early as third grade. “Alcohol consumption among youth doesn’t occur in a vacuum,” Dr. Barry says. “It’s really just trying to find evidence-based strategies that prevent drug use and then applying those in an alcohol setting.”

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INSERT 8

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

INSERT 8

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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