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Starting Young

Insight into adolescent addiction comes as new guidelines urge early prevention

Emotional Eating

Still Effective After All These Years After 80 years, AA still works No Woman No Cry The woman who doesn’t feel

The Opiate EPIDEMIC

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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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By Heather Hateld | WebMD Feature | Reviewed by Charlotte E. Grayson Mathis, MD EMOTIONAL EEAATTIINNGG EMOTIONAL AT

ere are several di erences between emotional hunger and physical hunger, according to the University of Texas Counseling and Mental Health Center web site: 1. Emotional hunger comes on suddenly; physical hunger occurs gradually. 2. When you are eating to ll a void that isn’t related to an empty stomach, you crave a specic food, such as pizza or ice cream, and only that food will meet your need. When you eat because you are actually hungry, you’re open to options. 3. Emotional hunger feels like it needs to be satised instantly with the food you crave; physical hunger can wait. 4. Even when you are full, if you’re eating to satisfy an emotional need, you’re more likely to keep eating. When you’re eating because you’re hungry, you’re more likely to stop when you’re full. r e

Are You an Emotional Eater?

You are an emotional eaters if you answer yes to any of the following questions: Do you ever eat without realizing you’re even doing it? Do you often feel guilty or ashamed after eating? Do you often eat alone or at odd locations, such as parked in your car outside your own house? After an unpleasant experience, such as an argument, do you eat even if you aren’t feeling hungry? Do you crave specic foods when you’re upset, such as always desiring chocolate when you feel depressed? Do you feel the urge to eat in response to outside cues like seeing food advertised on television? Do you eat because you feel there’s nothing else to do? Does eating make you feel better when you’re down or less focused on problems when you’re worried about something? If you eat unusually large quantities of food or you regularly eat until you feel uncomfortable to the point of nausea, you have a problem with binge eating. Please speak to your health care professional.

5. Emotional eating can leave behind feelings of guilt; eating when you are physically hungry does not. COMFORT FOODS When emotional hunger rumbles, one of its distinguishing characteristics is that you’re focused on a particular food, which is likely a comfort food. “Comfort foods are foods a person eats to obtain or maintain a feeling,” says Brian Wansink, PhD, director of the Food and Brand Lab at the University of Illinois. “Comfort foods are often wrongly associated with negative moods, and indeed, people often consume them when they’re down or depressed, but interestingly enough, comfort foods are also consumed to maintain good moods.” Ice cream is rst on the comfort food list. After ice cream, comfort foods break down by sex: For women it’s chocolate and cookies; for men it’s pizza, steak, and casserole, explains Wansink. And what you reach for when eating to satisfy an emotion depends on the emotion. According to an article by Wansink, published in the July 2000 American Demographics, “ e types of comfort foods a person is drawn toward varies depending on their mood. People in happy moods tended to prefer … foods such as pizza or steak (32%). Sad people reached for ice cream and cookies 39% of the time, and 36% of bored people opened up a bag of potato chips.”

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By Jennifer R. Scott | Updated February 15, 2014 Emotional eating can be a di£cult challenge when you are trying to lose weight. It’s a di£cult habit to break once it’s a part of your life, but by understanding what causes it and nding ways to cope that don’t involve food, you can overcome it. Read on to learn how to prevent and Prevent and Cope with Emotional Eating Before you can learn to cope with emotional eating, you must rst understand what it is. As the name implies, emotional eating is characterized by repeatedly eating in response to feelings rather in response to hunger to gain physical nourishment. Emotional eaters often consume large amounts of food at one sitting, which is sometimes referred to as a binge. Understand the Emotional Cues Many emotional eaters eat in response to ve common cues, which include boredom, loss of control and anger. Only you can know if these cues prompt you to eat emotionally: Eating a snack a few times a week because you are bored may not be a problem; eating a container of ice cream each time you’re angry probably is. Understanding these cues and learning how to choose another response — such as exercising to release pent-up anger —will help you end the cycle of eating in response to these feelings. Identify Your Triggers While many emotional eaters share cues in common, there may be certain feelings or situations that trigger you to eat that do not a ect someone else. One of the best ways to understand your own personal emotional eating triggers is to keep a “food and feelings” food diary. In it, you simply record what you eat and how you were feeling before, during and after your binge. Stress A ects Your Eating Habits Stress is one of the most common reasons that women in particular overeat. Stress is alleviated by eating certain foods and many women get in the habit of reducing tension by enjoying these foods rather than dealing with the source of their tension. By creating self-care skills that allow you to identify non-food solutions to tension-causing situations, you will be much less likely to cope with emotional eating. What is Emotional Eating?

(Please note: Extreme feelings of hopelessness are typical of chronic depression. Please talk to a mental health professional if you nd yourself feeling perpetually hopeless.) Lack of Control You think: My life is out of control. ere is nothing in it that I am in charge of. Everyone and everything around me rules my life. Except for eating…I can eat whatever I want, whenever I want it. So I will. Feeling Unappreciated Perhaps you’ve accomplished something exceptional at work and no one has noticed. Or maybe you’ve made a personal achievement you’d dreamed of for years. But no one at home shares your pride. You nd yourself tempted to congratulate yourself by “treating” yourself to a binge. Boredom ere’s nothing to do. Nowhere to go. Perhaps you feel lonely, too. ere’s nothing at home to occupy your mind or your hours. But there is a pantry full of comfort food that will kill some of that empty time. If you t into any one of these ve proles, try sitting down with a piece of paper and brainstorming to nd alternative behaviors to eating. You may be surprised at the solutions you come up with…and at just how well they work once you try them. en, write your ideas on notecards and post them where you will see them in your moment of need — how about on the refrigerator door or next to the pantry? Accepting why you eat the way you do can be a big step towards breaking the cycle of emotional eating.

eat emotionally after a stressful day. Let Go of All or Nothing inking

All or nothing thinking means you feel like you must do something perfectly or you should not do it at all. We often are either “on” our diets or “o ” of them. e sense of failure this brings can cause negative emotions that in turn trigger a binge. By allowing yourself the freedom to face every day as a fresh start and see every decision as independent of the one before it, you may nd emotional eating is much easier to avoid.

5 Common Emotional Eating Cues

By Jennifer R. Scott | Updated February 15, 2014

Emotional eating is the practice of consuming large quantities of food — usually “comfort” or junk foods — in response to feelings instead of hunger. Some of the common emotional eating cues are: Anger Whether you’re angry at yourself, another person or a situation, you stiªe your feelings using food rather than confronting them and releasing them. It’s easier to smother a problem than to

deal with it. Hopelessness

You think: Nothing really matters anyway. Nothings ever going to change or get better for me. So, why should I care about my health or weight? Besides, eating makes me feel better.

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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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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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"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:'

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“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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