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SMOKE SIGNALS Anti Fresh Empire’s anti-tobacco appeal is all about staying independent

TO END THE OPIATE EPIDEMIC

FIGHTING BRAIN DISEASE MODEL Model can complicate messaging In treatment plans FOR THE

GENERATIONAL BRAINDAMAGE Drinking during pregnancy presents parents with challenges beyond their own sobriety

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When you are addicted to tobacco, you are not in control. So says the main message of Fresh Empire, an Internet and TV campaign designed to inspire teens and young adults to stay away from cigarettes. Fresh Empire’s website—freshempire.betobaccofree.hhs.gov—has infor- mation and informational videos all about the consequences of smoking. Here, young people can learn about the chemical content of cigarettes, health risks associated with tobacco use and social drawbacks. Fresh Empire, sponsored by the U.S. Food and Drug Administration and U.S. Department of Health and Human Services (HHS), puts on events with performers such as rappers Silento and Stuey Roc, who deliver posi- tive, tobacco-free messages. “Being fresh is about yourself. The empire is yourself, man,” says radio per- sonality ET in video footage of a Fresh Empire concert. And Rock had this to say about tobacco use on a Fresh Empire video: “Smoking is not cool.” a nti-smoke Signals “Being fresh is about yourself. The empire is yourself, man.” - Radio personality ET Fresh Empire’s anti-tobacco appeal is all about staying independent

Tobacco statistics “What’s the deal with tobacco?” asks a Fresh Empire graphic. With this ques- tion, it launches into the ingredi- ents found in cigarettes, along with the health and social side effects of smoking. Images on Fresh Em- pire’s website show freshfaced youth looking directly into the camera as a way to deliver a straightforward and relatable source of information for young people. Fresh Empire does not rely on imag- ery alone. It also provides poignant statistics and cites research conduct- ed by the HHS and Internal Agency for Research on Cancer, among other organizations: •Cigarette smoking causes 480,000 deaths per year. • Smokers die, on average, 10 years younger than non-smokers. • 16 million people have at least one disease caused by smoking. A graphic on the site shows what Fresh Empire calls “all sorts of nasty chemicals” in tobacco, along with unsavory facts about those substanc- es. Listed first is carbon monoxide, which is found in car exhaust. Cig- arettes contain arsenic, Fresh Em- pire informs readers, which is used in pesticides. And there’s benzene, found in gasoline. Another header states simply “keep your cash,” which leads to a statistic that smoking half a pack a day costs an average of $1,000 per year. “That’s a lot of cash to blow on cig- arettes,” Fresh Empire states. “What would you rather spend $1,000 on?”

Online videos and TV ads The website has a series of short videos and TV ads, all with poignant soundbites and stories about the self-empowerment that comes from staying away from smoking. In a 30-second TV spot, young people, one after another, repeat the mantra, “I reject anything—including tobacco—that tries to control me.” Jayy Starr, a young hip-hop musi- cian, stars in a commercial where she tells the story of her grandfather. He smoked cigarettes for many years and died of lung cancer. “Losing my grandfather has influ- enced my whole musical being, because it makes me more passionate,” Starr says in a behind- the-scenes video for the ad. “I’m not going to lose

young man in sunglasses and a scarf. Throughout the videos, television ads and web content, Fresh Empire implores young people to think of cigarettes as an affront to autonomy. Surrendering to nicotine is not being in control, they say. Therefore, smoking is not fresh. “Losing my grandfather has influenced my whole musical being, because it makes me more passionate. I’m not going to lose another person to cigarettes. To me, being a leader means being

In another video, young people stand in the middle of the frame as messages flash on the screen alongside then. One reads “Long live Fresh Empire. Long live you. Live tobacco-free.” Another spot flashes empowering words for young women—“fresh,” “strong,” “boss,” “royal,” and “queen”—before a female voice-over says, “Fresh Empire is flippin’ the script in fash- ion, in hip-hop, in life.” Another video opens with the question “What’s Fresh Empire?” followed by a group of young people defining the tobacco-free movement. “It means looking out for you,” the first young man says. Another adds, “And your fam, too.” “When you are doing you, looking fresh, people follow,” says a stylish

tobacco-free.” -Singer Jayy Starr

another person to cigarettes. To me, being a leader means being tobacco free.”

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0 END THE

"Not only are the recommendations comprehensive they were developed with input from a wide range of stake- holders, and wherever possible draw from evidence-based research:'

SENSEOF URGENCY

“This is a complex epidemic with no simple solutions.” —Dr. G. Caleb Alexander, co-director of the Johns Hop- kins Center for Drug Safety and

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“The concept of addiction as a disease of the brain challenges deeply ingrained values about self-determination and personal responsibility.” – Dr. Nora Volkow, Dr. George Koob, Dr. AThomas McLellan

INSERT 3 Fighting for the Brain Disease Model Model can complicate messaging in treatment plans

Fighting public opinion can be an uphill battle, sometimes even a futile one. Despite years of progress and scientific advancements, researchers and treatment providers still find themselves having to convince the general public that substance use disorder is a disease. But it’s a message that can often complicate treatment plans as much as it seeks to inform.

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Setting the Record Straight Earlier this year, three of the nation’s leading drug experts wrote a paper seeking to explain, once and for all, how substance use affects the brain in the same way as similar diseases. In an article published in the New England Journal of Medicine, NIDA Director Dr. Nora Volkow, NIAAA Director Dr. George Koob, and Treatment Research Institute founder Dr. AThomas McLellan say they hope to reaffirm the brain disease model while simultaneously addressing common misconceptions about addiction. “The concept of addiction as a disease of the brain challenges deeply ingrained values about self-determination and personal responsibility that frame drug use as a voluntary, hedonistic act,” the authors write. The authors argue that public skepticism about the brain disease model comes from researchers’ inability to articulately describe the relationship between changes in neurobiology and the behaviors associated with addiction. Although countless scientific studies have proven the brain disease model to be accurate and effective, the authors admit more work may be needed to change public perception. “A more comprehensive understanding of the brain disease model of addiction may help to moderate some of the moral judgment attached to addictive behaviors and foster more scientific and public health–oriented approaches to prevention and treatment,” the authors write.

“You have to emphasize the responsibility on the part of the person, but you also have to explain why the behaviors are happening.” – Bob Rohret, MARRCH executive director

 Scientific studies attest that a person’s brain chemistry can be altered as a result of addiction.This fact can provide a needed explanation as to why continued use can still be a problem for people who clearly desire to get clean. “When you start to apply an explanation of why certain behaviors occur,” Rohret says, “it provides people some comfort in understanding why they’re doing what they’re doing.” Mixed Messages But as confident as many in the medical community are about the nature of substance abuse disorder, the idea that addiction is a disease presents something of a double-edged sword for treatment providers. “The messaging has to be sort of finessed,” says Bob Rohret, executive director of the Minnesota Association of Resources for Recovery and Chemical Health (MARRCH). “You have to emphasize the responsibility on the part of the person, but you also have to explain why the behaviors are happening.” Rohret says treatment providers have to inform those in recovery about the nature of their disease, while also making sure knowledge of that disease doesn’t become a crutch or an excuse for inaction. When presented correctly, Rohret says patients should understand their addiction and responsibility toward it in much the same way someone with heart disease may understand their affliction. Although they cannot change the biological makeup of their body immediately, they can make behavioral changes and take actionable steps that lead to more positive outcomes.

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HAS BEEN SHOWN TO PREVENT OVERDOSES AND STOP OPIOID “DESIGNER DRUGS” FROM AFFECTING THE BRAIN vaccine ? ARE A new

T

Treating addiction with vaccines is a relatively new idea with many unanswered questions

that arise out of a lack of research. But a new study suggests vaccinating against illicit drugs is not only possible, it could be extremely effective. At the Scripps Research Institute in California, researchers were looking for a way to guard against the lethal and addictive effects of synthetic opioid “designer drugs.” A potentially deadly opioid, fentanyl, is often used as a heroin substitute or mix-in by drug dealers, so researchers developed a vaccine to try to mitigate its effects. Researchers injected mice with three rounds of the vaccine and then exposed them to doses of fentanyl. They found the vaccinated mice did not display any “high” behaviors even months after the last series of vaccine injections. Researchers say the immune systems of the mice developed antibodies that successfully blocked the drug from reaching the brain. “The results were the best we’ve ever seen for any drug vaccine,” says Paul Bremer, a graduate student at Scripps Research Institute who worked on the study.

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VACCINES THE ANSWER

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The results were the best we’ve ever seen for any drug vaccine. - Paul Bremer, Scripps Research Institute

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“ WE WERE ABLE TO BLOCK EXTREMELY LARGE - Paul Bremer DOSES OF FENTANYL TO PROTECT AGAINST OVERDOSES

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SAFE AND POWERFUL Not only was the vaccine able to stop intoxication (something researchers suggest could aid in opioid addiction treatment), the vaccine also proved extremely effective in blocking the potentially lethal effects of fentanyl as well. While the chemical is not necessarily toxic in itself, it does produce psychoactive effects that can shut down breathing and stop a person’s heart. Researchers say mice injected with the vaccine could withstand doses of fentanyl up to 30 times the normal rate. “It was just a rst generation vaccine, but it did prove to be very potent,” Bremer says. “We were able to block extremely large doses of fentanyl to protect against overdoses.” A SINGLE PURPOSE Researchers say the vaccine would not protect against heroin or oxycodone, and a mixture of vaccines would be needed to protect against all opioids. But that was somewhat by design. To make sure the vaccine would not interfere with any medications a person may take responsibly later in life, researchers targeted speci c molecules so the vaccine would only block fentanyl and its derivatives.

“For unrelated drugs that you would be taking, there would be no effect from the vaccine,” Bremer says. LOOKING TOWARD THE FUTURE Although still in the early stages of development, researchers say the vaccine represents an exciting step forward in drug vaccine research. The lab is beginning more advanced trials on a similar heroin vaccine which should give them a better idea of how successful the fentanyl vaccine could become. But until more testing can be completed, researchers say they were pleased with the progress and excited for the future of vaccines in the treatment of addiction. “This concept of using a vaccine for addiction isn’t just an academic pursuit, it could really be used in practice,” Bremer says. “I think it’s really promising.”

safe and powerful

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Drinking during pregnancy presents parents with challenges beyond their own sobriety

Since its first diagnosis in 1973, Fetal Alcohol Spectrum Disorders (FASD) have shown how devastating drinking during pregnancy can be for an unborn child. Despite this fact, at least one in 10 pregnant women drink in the U.S. every year, according to a recent study by the Centers for Disease Control and Prevention. The CDC says children with FASD have physical issues like low birth weight and growth, problems with organ systems and damage to parts of the brain.These issues lead to behavioral and intellectual disabilities, hyperactivity, difficulty with attention, and poor communication, reasoning and judgment skills. The incurable situation can produce lifelong issues with school and social problems, mental health and substance abuse issues, difficulty keeping a job, living independently and having trouble with the law. In 2010, drinking while pregnant cost the U.S. $5.5 billion, says the CDC.

“ In 2010, drinking while pregnant cost the U.S. $5.5 billion. ” — Centers for Disease Control

“ I don’t know how I’m going to tell her. It was something I could have prevented. ” —mother of an FASD infant

Dysfunction in the family tree FASD can be multi-generational. Besides the common familial curse of addiction, the disability itself can contribute to bad impulse decisions, making it more likely for one to drink in the present moment and ignore the possible consequences. For that reason, a mother who has FASD herself may not recognize the symptoms of FASD in her child, because she views her own symptoms as normal. A mother in Tucson, Ariz., who was in recovery before realizing her drinking had caused FASD in her child, says the guilt was tremendous. Having to explain to her daughter why she had FASD was going to be the hardest thing she had ever done. “I don’t know how I’m going to tell her. It was something I could have prevented,” she says. Early diagnosis is key Diagnosing fetal alcohol syndrome can be difficult. A simple blood test will not suffice. Doctors typically look for abnormal facial features, such as a smooth fulcrum (the ridge most of us have between our nose and lips), lower than average height and weight, a small head and the birthmother’s admission of alcohol use during pregnancy. There are many treatment options, including medication for certain symptoms, behavioral therapies, education and training for parents. It is most helpful for children to be diagnosed before the age of six, be in a nurturing family environment and have access to special education and social services. Having FASD is not a hopeless situation. Implementing treatment strategies at a young age can help a child thrive despite the disorder.

 Regardless, it is never too late to quit drinking. Since brain growth takes place throughout a woman’s pregnancy, the sooner a woman quits drinking, the better off her baby will be. Prevention is best To prevent FASD, the best scenario is for a woman to refrain from drinking any amount of alcohol during pregnancy. Ideally, women should quit drinking the moment they go off birth control. “About half of all pregnancies in the United States are unplanned, and even if planned, most women won’t know they are pregnant for the first month or so, when they might still be drinking,” says Anne Schuchat, principal deputy director at the CDC.

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