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REDEFINING RECOVERY One Day at a Time takes a holistic approach to overcome addiction

Fighting Fire WITH FIRE Researchers look to combat addiction through repurposed pharmaceuticals

BOOMING- PROBLEM Eldery subtance abuse issues expected to grow as baby boomers age

ARE THE ANSWER V A C C I N E S

PLUS REDIFING RECOVERY

One Day at a Time takes a holistic approach to overcome addiction

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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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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.

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“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

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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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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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