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UNLIMITED BOUNDS RESOURCE GUIDE
Prevention ON WHEELS
Underserved & Undeterred Numbers Don’t Lie Fighting Fire With Fire Researchers look to combat addiction through repurposed pharmacceuticals
Redefining RECOVERY One Day at a Time takes a holistic approach
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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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Underserved And Undeterred Overcoming the unique challenges LGBTQ individuals face with addiction A s more and more addiction treatment centers are looking for ways to tailor programs to address the individual needs of clients, one section of the population is being largely overlooked. Advocates say treatment providers need to be more aware of the unique issues and barriers facing the LGBTQ community. Numbers don’t lie
For starters, statistics show substance abuse issues affect LGBTQ individuals at much higher rates than they do the heterosexual population. Some estimates show an addiction rate between 30 and 40 percent, compared to around 10 percent of the population in general. While statistics also show that LGBTQ individuals enter into treatment more readily than the rest of the country, they also face significantly higher animosity once in a program. Advocates say 46 percent of homosexual men and women have had a homophobic therapist, and 34 percent felt their sexuality was seen as irrelevant. While putting sexuality aside to address addiction directly may seem like a good thing at first glance, advocates say recognizing those differences is key to creating a lasting recovery. Need for understanding Understanding a person’s sexuality and gender identity can be as important as understanding their race or ethnic background in that it can uncover potentially hidden sources of stress or
trauma that may contribute to substance use. Just as counselors should consider the social experiences of African-Americans, so too should they consider the unique circumstances faced by members of the LGBTQ community. “In order to not continue to create trauma towards the LGBTQ community, the more culturally competent a person or work/recov- ery environment is, the better,” says Molly Gilbert, director of business development for the PRIDE Institute in Minnesota.
The PRIDE Institute specializes in addiction treatment for the LGBTQ community, and Gilbert says a lack of understanding or awareness by treatment providers can create barriers for people seeking treatment. Even for organizations that seek to become “inclusive” communities, they may not set up a program that accurately addresses LGBTQ concerns, or providers may not realize how they are doing harm to LGBTQ individuals, transgressions known as micro-aggressions. “Micro-aggressions occur daily towards the community and educating heterosexual colleagues, supporters and the rest of society is key in helping to diminish these daily slights and harm,” Gilbert says. Education first To improve treatment outcomes and the experi- ences of LGBTQ people in general, advocates say it’s vital that treatment pro-
viders, physicians, and social service employees educate themselves on
some of these unique challenges and barriers. But they also say LGBTQ people need to educate themselves as well. “Educating the LGBTQ community on the dangers of abuse of alcohol and drugs, and the fact that the community is actually being tar-
geted by institutions such as big tobacco, alcohol companies and drug manufacturers is key,” Gilbert says. With very few
LGBTQ-specific treatment centers across the country, advocates know many
LGBTQ individuals will end up in heteronormative treatment facilities. And while that can present prob-
lems, Gilbert says with the right education and the right system in place, recovery is attainable. “With the right therapy coexisting with a mainstream treatment center, we believe it is doable.”
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Prevention On Wheels BMXlife gives opportunities to at-risk youth through BMX bikes “I see the bikes as a means to get through to kids about other initiatives.” - David “Joby” Suender outreach coordinator and assistant to the president at ODAAT
BMXlife is a One Day at a Time (ODAAT) youth initiative that launches this summer to get kids on the streets - in a positive way. In its inaugural season, kids will learn pedestrian and bike safety, as well as the “rules of the road,” says David “Joby” Suender of ODAAT, who started the initiative. Many participants do not have access to bikes at home, so it could be their first time putting foot to pedal on one of 10 new bikes the program provides.
Beyond the riding, Suender hopes to convey bigger messages of pre- vention. “I see the bikes as a means to get through to kids about other initiatives - violence, drugs, healthy living,” he says.
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Philly freestylin’ Once they learn the basics, their sur- roundings provide ample room to progress. Suender says Philadelphia is particularly well-suited for BMX riding in particular, a form that can involve performing tricks on manmade features in the cityscape. “It’s great because of the environment that’s readily available to these kids,” Su- ender says. He goes on to describe the city’s features, historic and contemporary, that provide a wealth of obstacles for BMXers to tack- le. The city has been featured numerous times in skateboard and BMX videos, and a rider need not travel far to find a handrail to grind down, or a concrete ledge to jump off.
Two wheels, endless opportunities For those less inclined to the thrill of street riding, BMXlife covers many alternative aspects of riding. Suender says there are other valuable opportunities that biking can offer. He says having a hobby like biking can keep kids motivated and focused on something other than gangs and street life. The physical activity promotes healthy living, and the bike itself can serve as a sustainable means of transportation. Taking a look at the broader BMX industry, Suender says he will educate kids on filming, editing, photography and the mechanics of bike repair. “Maybe one of the kids won’t be into the riding aspect, but they’ll be into the mechanical side, or the filming and editing,” Suender says. “This will set them up with interests they can pursue down the road.” They are all skills Suender has successfully employed in his own BMX career. He says that BMX riding has enabled him to travel domestically and abroad, with his riding featured in videos, maga- zines and websites. It lends credibility to his message for the kids he works with, that they can do whatever they put their mind to. No matter which direction BMXlife leads its participants, the BMX culture presents opportunities that might not reach the kids through other media. And at the very least, Suender’s leadership sets an example for kids at risk. “I’m trying to provide a male role model and mentorship,” he says, “because a lot of these kids are coming from broken homes and don’t have any other outlets.” “Maybe one of the kids won’t be into the riding aspect, but they’ll be into the mechanical side, or the filming and editing. This will set them up with interests they can pursue down the road.” - David “Joby” Suender
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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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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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