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TO END THE OPIATE EPIDEMIC FROM SMOKING TO DRINKING

Fresh Empire’s anti-tobacco appeal is all about staying independent Online ANTI SMOKE SIGNALS

The Turning Point

WHEN IT RAINS, IT POURS

New study looks to pinpoint transition from prescription opioids to heroin

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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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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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0 END THE

"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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INSERT 8

Marijuana users are five times more likely to develop an alcohol abuse disorder, according to a new study

When it rains it pours. The old idiom may be familiar to many drug users who often find themselves battling more than one addiction. While previous research has shown multiple substance abuse disorders often go hand in hand, a new study suggests simply using marijuana can lead to a much higher risk of developing an alcohol use disorder.

Finding the Link Researchers at Columbia University analyzed data from 27,461 people who had used marijuana at the time of first testing, but had no history of alcohol related disorders. When researchers checked back three years later, they found marijuana users were five times more likely to have developed an alcohol abuse disorder.

Researchers said they were surprised the link wasn’t between marijuana use disorder, but simply marijuana use itself. “I think it’s important for people to be aware that there are certain behaviors that come with specific risks,” says Dr. Renee Goodwin, one of the lead researchers. “It would be particularly useful for youth.” Because youth are at a higher risk of experimenting with both drugs and alcohol, researchers said educating them about the total scope of risk is not only important, but could help curb problematic behaviors. “Preventing or delaying the onset of marijuana use could prevent or delay the onset of alcohol use disorder,” Dr. Goodwin says. “Statistically it should.”

“I think it’s important for people to be aware that there are certain behaviors that come with specific risks.” -Dr. Renee Goodwin

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“Preventing or delaying the onset of marijuana use could prevent or delay the onset of alcohol use disorder.” -Dr. Renee Goodwin

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Uses In Treatment For those already struggling with marijuana or alcohol use disorders, researchers said the knowledge that the two behaviors are linked could help people see the bigger picture of their addiction, and could prove useful in their journey toward recovery. “In some ways it may seem self- evident, but it may not be,” Dr. Goodwin says. “If you’re trying to quit drinking, it’s good to know that quitting marijuana could increase your chance of being successful.”

Zero relationship to mood and anxiety disorders As marijuana use has increased in the U.S., with some states even voting for legalization, some have wondered what the psychological cost will be to users. To investigate the question further, other researchers at Columbia University also conducted a recent study to determine if a link exists between increased marijuana use and psychiatric disorders. Although the results, published in the journal JAMA Psychiatry, mimicked previous research in showing a strong relationship between marijuana use and other substance abuse disorders, the findings in regards to psychiatric disorders were much different. The study showed no relationship between marijuana use and increased instances of mood and anxiety disorders, only substance abuse disorders. But despite the lack of a connection, researchers still cautioned against public policy that could lead to increased marijuana use. “The lack of association between more frequent cannabis use with increased risk of most mood and anxiety disorders does not diminish the important public health significance of the association between cannabis use and increased prevalence and incidence of drug and alcohol use disorders,” the authors wrote. 

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INSERT 9

New study looks to pinpoint transition from prescription opioids to heroin

Stopping heroin use before it begins may be the best remedy for the country’s growing epidemic. A new study looks to pinpoint the times and ways that young people rst use the dangerous drug in hopes of strengthening prevention efforts. For three years, researchers at Wright State University tracked nearly 400 18- to 23-year-olds in Columbus, Ohio, who used illicit prescription opioids but were not opioid-dependent. Of the 362 participants, 27 eventually transitioned to heroin, a rate of 7.5 percent. “We were surprised at the number of people who transitioned to heroin,” says Dr. Robert Carlson, the study’s lead researcher. “We had really no idea of what exactly we’d be able to predict.”

Predicting risk

Researchers found several predictors of increased risk of heroin use, starting with the ways in which the opioids were being used. Those who crushed or snorted the prescription drugs were far more likely to transition to heroin. “It increases the speed at which the drug is hitting the system and makes people much more liable to becoming dependent,” Dr. Carlson says. “If people can become aware that if they even think about starting to use via a non-oral route, they are heading off on a very dangerous path.”

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“We were surprised at the number of people who transitioned to heroin. ” - Dr. Robert Carlson, Wright State University

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Racial divide

The new NIDA-funded study targeted 18- to 23-year-olds because they are arguably at the highest risk for substance abuse. The study did not look at other age groups. But when considering the factors that may move a person from prescription opioids to heroin, Dr. Carlson believes age is just a number. “I wouldn’t think the risk factors for transition to heroin would be much different regardless of age group,” Dr. Carlson says. While the risk factors may be the same across age groups, the most deadly effects of heroin use are not. Research has shown that those most at risk of a heroin-related overdose fall in the 25 to 44 age range. It’s important to keep in mind that the vast majority of prescription opioid users will not move on to heroin. And signi cant research is still needed to determine the social, environmental and biological factors that contribute to a person transitioning to heroin. But Dr. Carlson says he’s encouraged by the progress being made and believes the groundwork has been laid to develop effective treatment and intervention programs. “The really exciting thing to come out of this is it really gives us a rm foundation of some variables that could be targeted to prevent transition to heroin and transition to dependence,” Dr. Carlson says. Targeted approach The study also saw a difference in race among those who eventually turned to heroin. Despite roughly half the participants being African-American or Hispanic, all of the individuals who ultimately used heroin were white. Although the study could not determine the reasons behind such a strong racial divide, Dr. Carlson suggests that social networks, generational use and other circumstances could be signi cant factors. National data shows the heroin epidemic has increasingly hit white males the hardest. The Centers for Disease Control estimates that between 2002 and 2013, heroin use among non-Hispanic whites increased 114 percent. Age is just a number

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