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REHABILTATION CLINIC METROPOLITAN

RESOURCE GUIDE

ANTI-SMOKE SIGNALS Fresh Empire’s anti-tobacco appeal is all about staying independent FIGHTING FIRE with FIRE Researchers look to combat addiction through reproposed pharmaceuticals

RELAPSE TRACKERS

BOOMING PROBLEMS

ELDERLY SUBTANCE ABUSE ISSUES EXPECTED TO GROW AS BABY BOOMERS AGE

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.”

FIGHTING FIRE WITH FIRE

“I think this opens up a large world view with regards to this system in the brain.” - Dr. Heath Schmidt

“These results are very provocative and suggest these compounds could be repur- posed for drug addiction.” - Dr. Heath Schmidt,

University of Pennsylvania

D espite years of stigma, medication-assisted treatment (MAT) is steadily gaining in popularity among treatment providers. Government groups like the U.S. Department of Health and Human Services are actively campaigning to get more providers to offer MAT as a potentially vital resource for patients. While such groups often promote well-known medications such as methadone and buprenorphine, drug researchers are looking for new medications that could be a lifeline to patients in need. But new medications can cost millions to research and take years to get on the market. That’s why some researchers are taking a closer look, and finding success, with drugs already approved by the FDA. CURBING COCAINE USE Researchers at the University of Pennsylvania say a drug already on the market for diabetes may be able to curb cocaine use. The FDA-approved drug Byetta, used to regulate blood sugar in diabetic patients, is derived from a natural hormone known as GLP-1. The research team looked at how the hormone functioned in rats and found that the same hormone that regulates food intake could be used to suppress cocaine consump- tion. “These results are very provocative and suggest these compounds could be repurposed for drug addiction,” says Dr. Heath Schmidt, one of the lead researchers. “We have seen a reduction in cocaine consumption…but it doesn’t completely abolish it.” Currently, there is no FDA-approved drug for the treatment of cocaine abuse. But because Byetta and a similar drug have already gained federal approval, researchers say that leaves fewer hurdles before they could be used in treatment settings. Although still far from human trials, research- ers say they’re optimistic, especially because their research suggests the hormone is not specific to cocaine and could be used in treatment of other substance abuse disorders. “I think this opens up a large world view with regards to this system in the brain,” Dr. Schmidt says. “There’s really a lot to be explored here and I think it’s really an exciting time to be in the field and exploring the GLP- 1 system.”

ADJUSTING ALCOHOL CONSUMPTION Another team of researchers at the University of Queensland in Australia believe the FDA-approved drug pindolol could be used to stop alcohol abuse. Pindolol is an anti-hypertensive medication used to treat high blood pres- sure. But because of the way it interacts with neurotransmit- ters in the brain, they believe it could also be effective in treating alcohol use disorders (AUDs). To study the drug’s effect, the team used mice and exposed them to an alcohol consump- tion regimen similar to a binge drinking cycle common in humans. For mice also given pindolol, the team found they were able to reduce drinking in the long term (after at least 12 weeks). The team did not see as positive of results in the short term (only four weeks), but they say they’re still excited about its potential uses. “Although further mechanistic investigations are required, this study demonstrates the poten- tial of pindolol as a new treat- ment option for AUDs that can be fast-tracked into human clin- ical studies,” the authors wrote.

“There’s a lot of information that can be gained from when somebody relapses.” - Dr. Stephanie Carreiro, University of Massachusetts

Fitness trackers could help prevent relapses

Dr. Carreiro says wearable biosensors can detect a relapse event for some substances (like heroin and cocaine) by sensing a change in heart rate or other physical conditions. The treatment provider can then use the fitness tracker ’s other information, like the time and location of the relapse event, to develop a profile about the conditions that prompt a patient to use. “It gives us very specific contextual information and serves as that reminder to the patient that someone could potentially know right away when they relapse,” Dr. Carreiro says.

Fitness trackers, or wearable biosensors, like Fitbit and Jawbone are the latest fitness trend to gain widespread popularity. But some believe they could be used to treat addiction as well. New research suggests the devices can be used to reliably detect relapses, which could then give treatment providers the information they need to prevent relapses in the future. “There’ s a lot of information that can be gained from when somebody relapses,” says Dr. Stephanie Carreiro, a researcher from the University of Massachusetts.

ACCOUNTABILITY MATTERS That accountability to someone who could see the relapse is an important step in moving past simple self-reporting and drug testing. People can lie during self-reports and drug testing will only show that drugs were used, but not information like how much was used, when it was used, and where. Because the sensors can be easily removed, the system will only work for patients who are truly motivat- ed to stay sober. Dr . Carreiro says rather than a big brother scenario with treatment providers tracking a patient’s movements, the devices simply connect a patient to their support network. “We could potentially trigger an interaction with a patient just seeing if they’re okay and need some help,” Dr. Carreiro says.

“It definitely served as a reminder that there was something motivating them to stay sober.”

- Dr. Stephanie Carreiro

SIMPLE REMINDER In a study of 15 patients, nearly everyone kept wearing the devices even when relapsing. D r. Car- reiro says that’s because many people are already used to wearing fitness trackers, and the treatment plan simply fits into the daily routines they’ve al - ready established. Researchers also say just having a physical object on a patient ’s wrist to remind them about their dedication to sobriety can be enough to prevent a relapse. “Multiple people looked at it and thought of going back to jail or being there for their children,” D r. Carreiro says. “It definitely served as a reminder that there was something motivating them to stay sobe r.”

WHAT ABOUT PREVENTION? The ultimate goal is to prevent relapses and keep patients on the path to sobriety. While the tech- nology is advancing quickl y, researchers say the collective knowledge base simply isn ’t there yet to predict a relapse event. But as they conduct more studies and develop better algorithms with the information gained, they should be able to tailor interventions to a specific patient and hopefully keep them from relapsing. “We need to continue to define different pro - files so that we can get a more complete under - standing of what ’ s happening,” D r. Carreiro says. “That’s when it will be the most powerful.”

“Everythingwe knowabout older adults and substance abuse probably doesn’t apply to Baby Boomers.” - Dr. Alexis Kuerbis, CUNY - Hunter College

overall numbers present a problem. “We’re grossly understaffed in being able to handle these problems,” says Dr. Dan Blazer, a psychiatrist at Duke University who has studied the issue extensive­ ly. “It’s a problem. I think it’s a problem that’s going to get larger as time goes on and we’re probably already seeing evidence of that.” But there’s also an issue of attitude. Baby Boomers, in general, have a more relaxed view of substance use, and experts fear they may carry those behaviors later into life. “There’s no evidence that they’re going to automati­ cally stop when they hit 65 years old,” Dr. Blazer says. “They’ve used them all their life, they say, ‘Why shouldn’t I use them now?’”

Even though elderly people show substance abuse issues in a much lower percentage than other age groups, the problem is more prevalent than many realize. And it appears it’s only going to get worse. Studies vary, but generally show between 2.2 and 9 percent of older adults have an alcohol use disor­ der, and experts say they’re already seeing a rise in marijuana and opioid abuse issues. With the large population of Baby Boomers aging, substance abuse numbers in the elderly population are expected to continue to rise, presenting serious problems for treat­ ment providers and family members. Researchers say the problem is twofold: part is sheer numbers, the other is attitude. With the number of older adults in the U.S. expected to increase from 40.3 million to 72.1 million between 2010 and 2030,

HIDDEN DANGERS

Experts say the lifestyle of elderly people presents a unique challenge for physicians and treatment providers. For example, because retired people don’t work, substance use doesn’t present a problem at their jobs, a typical red flag for younger people. Experts also say too often doctors fall victim to their own prejudices and don’t ask the right questions that could lead to a diagnosis.

Although success rates in treat­ ment can be better for older adults, the way they’re treated isn’t necessarily the same. Dr. Sacco says older adults respond better to more collaborative treat­ ment programs that give them options. “For so long it was trying to fit older adults into these programs, but now it might be chang­ ing these programs to fit older adults,” Dr. Sacco says.

“People think this person doesn’t look like a substance user,” says Dr. Paul Sacco, an expert on substance abuse in older adults. “Sometimes physical problems associated with alcohol abuse are assumed to have a different cause in older adults.” Substance abuse can be even risk­ ier for older adults as their bodies become less resistant to the stress­ es brought on by substance use.

PLANNING AHEAD

To mitigate the expected problems as much as possi­ ble, experts say we need to train more counselors and physicians on how to best treat older adults, and how to spot potential problems in the first place. “With just a little bit of education about older adults, I think you could make a very big impact,” says Dr. Alexis Kuerbis, a researcher who also works with older adults. “The first step is awareness on what might be

different for an older adult.” But because Baby Boomers use substances more than previous senior groups have, experts say treatment providers may have to find new ways to treat an old problem. “Everything we know about older adults and substance abuse probably doesn’t apply to Baby Boomers,” Dr. Kuerbis says. “All bets are off.”

“We’re grossly understaffed in being able to handle these problems.” - Dr. Dan Blazer, Duke University

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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