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Giving Addicts a “Reset” Developers working on first digital therapy app for addiction.

Study finds ALCOHOL changes the brain from the very first DRINK.

Starting THE PROLONGING P ain Young

All These Years Still Efffective After

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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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Giving addicts a “reset ” Developers working on first digital therapy app for addiction One reason the opioid addiction epidemic has taken hold in many rural areas is that many Americans with substance use disorder live long distances from the nearest treatment providers. But a new tool may provide hope.The U.S Food and Drug Administration (FDA) is currently reviewing a new tool that may help remedy that geographical problem: the first prescription digital therapy designed to treat SUD. Boston and San Francisco-based Pear Therapeutics developed reSET, a mobile app used as a treatment tool concurrently with outpatient therapy centered on SUDs.The project has demonstrated better abstinence and treatment retention when applied alongside face-to-face therapy focused on SUD-related treatments for alcohol, marijuana, cocaine and stimulants.The therapy also includes a web-based program for healthcare providers. An app to help opiate addicts Pear is also developing reSET-0, an app specifically designed to help opiate addicts. Both apps consist of a patient-facing smartphone application and a clinician-facing web interface. The company raised $20 million last year with the aid of various venture companies including Arboretum Ventures, an Ann Arbor, Mich.-based venture capital firm. “(reSET) will give patients and clinicians a new tool to improve therapy specifically in an area right now that is a true health epidemic in the U.S,” Dr.Thomas Shehab, managing director at Arboretum Ventures, told DrugAddictionNow.com. “It’s an extremely novel approach to central nervous system and behavioral health diseases that we didn’t see anyone else addressing in that way.”

Pear submitted reSET for review by the FDA during the first half of 2016 and says it is expected to be approved this year. Dr. Shehab said his firm is “particularly intrigued by their approach because it’s a combination of a very well-studied digital therapy being used in conjunction with other therapies.” He says, “We thought the unique makeup of the Pear team and their unique approach to digital therapies really made us feel it had the highest likelihood of success in really helping address these issues.”

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According to data provided by Pear Therapeutics, 507 people with SUD from 10 treatment centers nationally received either face-to-face therapy or reduced volume of face-to-face therapy with reSET.They were given 12 weeks of outpatient therapy with or without using the app; if without, a portion of the digital therapy was replaced with face-to-face therapy. Abstinence was calculated two times weekly through a breathalyzer, urine samples and self-reports. Of the participants dependent on alcohol, marijuana, cocaine and stimulants, 58.1 percent of them receiving treatment with reSET were abstinent during weeks nine through 12, versus 29.8 percent of participants receiving only face-to-face therapy. Of the participants who started the study with a positive drug test, 26.7 percent of them who received reSET were abstinent during weeks nine through 12 of the study; only 3.2 percent of those that received traditional face-to-face therapy reported abstinence during the same time period. Participants using reSET presented statistically significant advancement in retention rates compared to those not using the app. After 12 weeks, 59 percent of participants that received face-to-face therapy retained sobriety in comparison to the 67 percent of those that used reSET.The reSET-O app has shown promising results in

three independent and randomized clinical trials, the company says. A study of 465 participants that completed outpatient methadone or buprenorphine treatment for opioid addiction was conducted, in which the participants were given standardized face-to-face therapy or shortened standardized treatment with reSET-O.Their abstinence was determined by self-reporting and urine tests. The developers plan to submit reSET-O to the FDA for approval, pending approval of reSET. “With all that’s going on, this is a very exciting company that we’re very enthusiastic about because it benefits a group of patients in great need,” Dr. Shehab said. “We think that reSET has a lot of potential.”

Maker receives NIDA grant In July, Pear announced it

has received a Small Business Innovation Research (SBIR) Fast-Track award funded by the National Institute on Drug Abuse (NIDA). PEAR will collaborate with CleanSlate Research and Education Foundation and Columbia University Medical Center Department of Psychiatry’s Division on Substance Use Disorders on the project. The grant will support the application of “enhanced engagement and gamification mechanisms” to reSET and reSET-O, the company says.

“It benefits a group of patients in great need.” - Dr.Thomas Shehab, Arboretum Ventures

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ain relievers are supposed to relieve pain. It sounds simple enough, but new research suggests a common pain medication may actually be prolonging chronic pain. P Prolonging the Study suggests painkillers may be having the opposite effect in the long run Pain

“We were surprised that morphine was able to induce these really long-lasting changes,” says Dr. Peter Grace, the study’s lead author. Dr. Grace says the cause of the chronic pain in- crease has to do with cells that form part of the immune system. He says if those areas could be isolated or their effects reduced, the resulting pain may not be as great. “If it does turn out to be a relevant issue to patients, then what our study suggests is that targeting the immune system may be the key to avoiding these kinds of effects,” Dr. Grace says. “Opioids could essentially work better if we could shut down the immune system in the spinal cord.” The team’s research only looked at spinal cord injuries and morphine, and did not study other opioids that are commonly prescribed to pa- tients experiencing pain. But he said it’s likely drugs like Vicodin or OxyContin could affect other parts of the body in a similar way. “While we haven't actually tested other opioids in this particular paradigm, we predict that we would see similar effects,” Dr. Grace says.

Morphine is an opioid painkiller commonly prescribed in hospitals and clinics, and while it is effective in the short term, doctors don’t always consider the potential consequences for pain down the road. That’s why a team of researchers based out of the University of Col- orado - Boulder set out to study how morphine treatment affects chronic pain, and found some troubling results. The team, which used mice with spinal cord injuries, found that in mice not given morphine, their pain thresholds went back to normal about four to five weeks after the injury. But mice who were given morphine didn’t see their pain levels return to normal until around 10 to 11 weeks, meaning the use of morphine effectively dou- bled the length of their chronic pain.

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Chronic problem Chronic pain can be debilitating for many people facing serious health problems, and it can also be a key factor in substance abuse. Many people report developing a dependence on opioids after having them prescribed for an injury. But new research suggests the number of people who develop dependency issues because of chronic pain may be far higher than people realize. A study from researchers at Boston Univer- sity looked at a group of nearly 600 people who had either used illicit substances or misused prescription drugs.

They found that 87 percent reported suffering from chronic pain, with 50 percent of those people rating their pain as severe. They also found that 51 percent of people who had used illicit drugs like marijuana, cocaine and heroin had done so to treat their pain. While many prevention ef- forts focus on recreational users, the numbers suggest that chronic pain plays just as prominent a role in substance abuse. “Many patients using illicit drugs, misusing prescription drugs and using alcohol reported doing so in order to self-medicate their pain,” the authors of the study wrote. “Pain needs to be addressed when patients are counseled about their substance use.”

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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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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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