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STARTING YOUNG INSIGHT INTO ADOLESCENT ADDICTION COMES AS NEW GUIDLINES URGE EARLY PREVENTION

PROLONGING THE PAIN STUDY SUGGESTS PAINKILLERS MAY BE HAVING OPPOSITE EFFECT IN THE LONG RUN

ONE DAY AT A TIME TAKES HOLISTIC APPROACH TO OVERCOME ADDICTION REDEFINING RECOVERY

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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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"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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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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Redefining Recovery One Day at a Time takes a holistic approach to overcome addiction

Recovery can be a tricky word. For some it’s short- hand for overcoming chemical dependence, while others distinguish it from words like “abstinence” or “sobriety.”The word represents what an individ- ual does with a new life — how one uses past expe- riences to overcome hardship and thrive spiritually. One Day at a Time (ODAAT) recognizes that this distinction applies to populations beyond addicts and alcoholics, and aims to serve anyone in need of a fresh start. “When we say ‘recovery,’ we’re not just talking about drugs and alcohol,” says President Mel Wells. “We mean any challenges in life.”The support for addiction recovery is there, Wells says, but it rep- resents just one of ODAAT’s holistic services; they also address homelessness, HIV/ AIDS, poverty, and violence and gang prevention, to name a few. Historically speaking, ODAAT’s primary services give shelter and supportive housing to those in need. They have 60 beds for recovering addicts and alcoholics, a men’s and women’s house, each hold- ing 14 residents, and a 38-bed homeless shelter known as Safe Haven. The men’s and women’s homes work with clients to afford them low-cost, supportive housing; Safe Haven and the drug and alcohol facilities are state- and cityfunded, and do not charge rent.

“When we say ‘recovery,’ we’re not just talking about drugs and alcohol. We mean any challenges in life.” - Mel Wells president of One Day at a Time (ODAAT)

“In a lot of cases, the person who has been through those struggles is going to be more driven in life and more successful.” - Mel Wells president of One Day at a Time (ODAAT)

No one left behind Wells takes pride in ODAAT’s “no one turned away” ethos. He says instead of turning people away, the organization has always made room or given referrals to prospective cli- ents on the spot. ODAAT has reach spanning as far away as London and Cambodia, Wells says. In Philadel- phia, ODAAT reaches up to 56,000 people annually, a figure Wells hopes to increase to 70,000 in the coming years. The city of Philadelphia and state of Pennsylvania have picked up on ODAAT’s efficacy, Wells says, and approved increased funding, allowing ODAAT to reach more and more people every day. Not only does ODAAT welcome everyone, it does it fast. ODAAT has staff on hand at all hours to handle incoming clients who often have nowhere else to go. There’s a narrow time frame in which some- one is ready and willing to receive help, and Wells doesn’t want to miss it. “They might change their mind, or they might not even have the chance to. They might not make it another day,” Wells says, speaking to the fatality of life on the streets and in active addiction.

Learning from each other Clients at ODAAT benefit from its widespread acceptance, and Wells says they gain a rare opportunity to grow from others’ stories. With an open, empathetic ear, clients gain insight to struggles they might not know firsthand. For instance, Wells describes the scenario of a recovering addict getting to know an AIDS patient — the addict might have no idea what a person with AIDS goes through every day to stay well, and vice versa. A new perspective can change a client’s attitude toward recovery. And for someone to survive and prosper through any number of life’s challenges, Wells notes, there is no telling what they are capable of. “In a lot of cases, the person who has been through those struggles and comes out is going to be more driven in life and more successful,” he says.

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“It’s really just about being around like-minded people and developing that ‘we’ as a support system.”

– Dr. Gerard Love, Slippery Rock University

INSERT 5 “It’s really just about being around like-minded people and developing that ‘we’ as a support system,” Dr. Love says. Dr. Love says simply having a recovery space

“Universities are supposed to be about dialogue, and having this is a great opportunity for dialogue,” Dr. Love says. “Bringing this whole notion of addiction out of the shadows and increasing understanding, I think will be a good byproduct of this.”

on a college campus could help change perceptions about recovery and remove the stigma surrounding addiction.

Of cials at the University of Minnesota – Rochester will also be opening a new recovery LLC for the fall 2016 semester. Of cials say it’s necessary to provide recovering students with the tools they need to succeed academically and in their personal lives. “Historically, students who are in recovery really struggle to come back to campus without that [supportive housing] program,” says Kris Barry, the school’s health and wellness advocate. The LLC will house six to 10 students and feature evidence-based recovery programming. Of cials say the LLC speaks to the school’s mission as a health-focused university. But more than that, they say they hope to foster a culture of personal growth among all students, particularly those in recovery. “I see them as being leaders here on campus and then taking that and changing the dialogue about addiction,” Barry says. “We know that the traditional college experience can be hostile to the goals of anyone in recovery, and we want to support them as much as possible.”

Boyd Austin says student communities centered on recovery provide a welcome relief for students to explore their university in a supportive and positive way. “It o ers a space, it o ers a culture, it o ers a community of people who are engaging in college in the same way,” Boyd Austin says.

Experts say universities are increasingly adding recovery programs focused on creating a community among students, but ones incorporating housing are still few and far between. “This started about 30 years ago, but it has really taken off in the last 10 years,” says Amy Boyd Austin, president-elect of the Association of Recovery in Higher Education.

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The road to recovery is easier with help from the right people.

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