Substance Abuse News

Researchers at Weill Cornell Medical College have successfully tested their novel anti-cocaine vaccine in primates, bringing them closer to launching human clinical trials.

Their study, published online by the journal Neuropsychopharmacology, used a radiological technique to demonstrate that the anti-cocaine vaccine prevented the drug from reaching the brain and producing a dopamine-induced high.

“The vaccine eats up the cocaine in the blood like a little Pac-man before it can reach the brain,” says the study’s lead investigator, Dr. Ronald G. Crystal, chairman of the Department of Genetic Medicine at Weill Cornell Medical College.

Breaking the Addiction

“We believe this strategy is a win-win for those individuals, among the estimated 1.4 million cocaine users in the United States, who are committed to breaking their addiction to the drug,” he says. “Even if a person who receives the anti-cocaine vaccine falls off the wagon, cocaine will have no effect.”

Dr. Crystal says he expects to begin human testing of the anti-cocaine vaccine within a year.

Cocaine, a tiny molecule drug, works to produce feelings of pleasure because it blocks the recycling of dopamine — the so-called “pleasure” neurotransmitter — in two areas of the brain, the putamen in the forebrain and the caudate nucleus in the brain’s center. When dopamine accumulates at the nerve endings, “you get this massive flooding of dopamine and that is the feel good part of the cocaine high,” says Dr. Crystal.

Immune System Fights Cocaine

The novel vaccine Dr. Crystal and his colleagues developed combines bits of the common cold virus with a particle that mimics the structure of cocaine. When the vaccine is injected into an animal, its body “sees” the cold virus and mounts an immune response against both the virus and the cocaine impersonator that is hooked to it. “The immune system learns to see cocaine as an intruder,” says Dr. Crystal. “Once immune cells are educated to regard cocaine as the enemy, it produces antibodies, from that moment on, against cocaine the moment the drug enters the body.”

In their first study in animals, the researchers injected billions of their viral concoction into laboratory mice, and found a strong immune response was generated against the vaccine. Also, when the scientists extracted the antibodies produced by the mice and put them in test tubes, it gobbled up cocaine. They also saw that mice that received both the vaccine and cocaine were much less hyperactive than untreated mice given cocaine.

Booster Shots to Dampen the Cocaine High

In this study, the researchers sought to precisely define how effective the anti-cocaine vaccine is in non-human primates, who are closer in biology to humans than mice.

They developed a tool to measure how much cocaine attached to the dopamine transporter, which picks up dopamine in the synapse between neurons and brings it out to be recycled. If cocaine is in the brain, it binds on to the transporter, effectively blocking the transporter from ferrying dopamine out of the synapse, keeping the neurotransmitter active to produce a drug high.

In the study, the researchers attached a short-lived isotope tracer to the dopamine transporter. The activity of the tracer could be seen using positron emission tomography (PET). The tool measured how much of the tracer attached to the dopamine receptor in the presence or absence of cocaine.

Reducing Cocaine Occupancy

The PET studies showed no difference in the binding of the tracer to the dopamine transporter in vaccinated compared to unvaccinated animals if these two groups were not given cocaine. But when cocaine was given to the primates, there was a significant drop in activity of the tracer in non-vaccinated animals. That meant that without the vaccine, cocaine displaced the tracer in binding to the dopamine receptor.

Previous research had shown in humans that at least 47 percent of the dopamine transporter had to be occupied by cocaine in order to produce a drug high. The researchers found, in vaccinated primates, that cocaine occupancy of the dopamine receptor was reduced to levels of less than 20 percent.

“This is a direct demonstration in a large animal, using nuclear medicine technology, that we can reduce the amount of cocaine that reaches the brain sufficiently so that it is below the threshold by which you get the high,” says Dr. Crystal.

Frequency of Vaccine?

When the vaccine is studied in humans, the non-toxic dopamine transporter tracer can be used to help study its effectiveness as well, he adds.

The researchers do not know how often the vaccine needs to be administered in humans to maintain its anti-cocaine effect. One vaccine lasted 13 weeks in mice and seven weeks in non-human primates.

“An anti-cocaine vaccination will require booster shots in humans, but we don’t know yet how often these booster shots will be needed,” says Dr. Crystal. “I believe that for those people who desperately want to break their addiction, a series of vaccinations will help.”

Teen smokers who rationalize their use of cigarettes by saying, “At least, I’m not doing drugs,” may not always be able to use that line.

New research to be presented Sunday, May 5, at the Pediatric Academic Societies (PAS) annual meeting in Washington, DC, supports the theory that cigarettes are a gateway drug to marijuana.

Smoking More Tobacco

“Contrary to what we would expect, we also found that students who smoked both tobacco and marijuana were more likely to smoke more tobacco than those who smoked only tobacco,” said study author Megan Moreno, MD, MSEd, MPH, FAAP, an investigator at Seattle Children’s Research Institute and associate professor of pediatrics at the University of Washington.

Dr. Moreno and her colleagues randomly selected incoming college students from two universities — one in the Northwest and one in the Midwest — to participate in the longitudinal study. Students were interviewed prior to entering college and again at the end of their freshman year regarding their attitudes, intentions and experiences with substances.

One-Third Smoke Tobacco

Specifically, students were asked if they had used tobacco or marijuana ever in their lives and in the past 28 days. Researchers also assessed the quantity and frequency of marijuana and tobacco use in the past 28 days.

Results showed that prior to entering college, 33 percent of the 315 participants reported lifetime tobacco use, and 43 percent of lifetime users were current users. In addition, tobacco users were more likely to have used marijuana than those who did not use tobacco.

By the end of their freshman year, 66 percent of participants who reported tobacco use prior to entering college remained current users with an average of 34 tobacco episodes per month. Of these, 53 percent reported concurrent marijuana use. Overall, users of both substances averaged significantly more tobacco episodes per month than current users of tobacco only (42 vs. 24).

Increased Use of Tobacco

“These findings are significant because in the past year we have seen legislation passed that legalizes marijuana in two states,” Dr. Moreno said. “While the impact of these laws on marijuana use is a critical issue, our findings suggest that we should also consider whether increased marijuana use will impact tobacco use among older adolescents.”

Future work should involve designing educational campaigns highlighting the increased risks of using these substances together, Dr. Moreno concluded.

A group of researchers from Sweden have provided further evidence that illegal drugs can be detected in the breath, opening up the possibility of a roadside breathalyzer test to detect substances such as cocaine, amphetamines and cannabis.

Using a simple, commercially available breath sampler, the researchers have successfully identified a range of 12 substances in the breath of 40 patients recruited from a drug emergency clinic in Stockholm.

Their findings have been published in IOP Publishing’s Journal of Breath Research.

Advantages of Breath Tests

Blood, urine and saliva are the most popular methods for detecting illegal drugs and are already used by law enforcement in a number of countries; however, exhaled breath is seen as a promising alternative as it’s easier to collect, non-invasive, less prone to adulteration and advantageous when location becomes an obstacle, such as at the roadside.

Exhaled breath contains very small particles that carry non-volatile substances from the airway lining fluid. Any compound that has been inhaled, or is present in the blood, may contaminate this fluid and pass into the breath when the airways open. The compounds will then be exhaled and can subsequently be detected.

In this study, researchers from the Karolinska Institute in Stockholm collected breath, blood plasma and urine samples from 47 patients (38 males, 9 females) who had taken drugs in the previous 24 hours and were recovering at a drug addiction emergency clinic.

Analyzing the Samples

Interviews were also undertaken with each patient to assess their history of drug use.

The breath samples were taken using a commercially available sampling device – SensAbues – and then analysed using liquid chromatography and mass spectrometry.

The portable sampling device consists of a mouth piece and a micro-particle filter. When a patient breathes into the mouth piece, saliva and larger particles are separated from the micro-particles that need to be measured.

The micro-particles are able to pass through and deposit onto a filter, which can then be sealed and stored ready for analysis. Breath samples were analysed for twelve substances.

Alprazolam and benzoylecgonine were detected in exhaled breath for the first time, whereas for methadone, amphetamine, methamphetamine, cocaine, morphine, 6-acetylmorphine, tetrahydrocannabinol, buprenorphine, diazepam and oxazepam, the results confirmed previous observations.

Detected 24 Hours Later

“Considering the samples were taken 24 hours after the intake of drugs, we were surprised to find that there was still high detectability for most drugs,” said lead author of the study Professor Olof Beck.

“In cases of suspected driving under the influence of drugs, blood samples could be taken in parallel with breath when back at a police station. Future studies should therefore test the correlation between blood concentration of drugs of abuse and the concentrations in exhaled breath.”

A potential new treatment for alcoholism called nalmefene is effective and safe for reducing alcohol consumption in alcohol dependent individuals, says a new study published this week in Biological Psychiatry.

Traditionally, abstinence has been regarded as the primary treatment goal for alcohol dependence, and current pharmacological treatments for alcoholism are approved only for relapse prevention. However, relapse rates remain high and a goal of abstinence is unacceptable to many patients. To address these concerns and provide opportunities for improved patient outcomes, new evidence-based treatments are necessary.

New Alcoholism Treatment Shift

“Our new findings may mark a true paradigm shift in the treatment of men and women who suffer from alcohol related disorders. While abstinence should be the best bet, a reduction in consumption may be a valuable alternative for the many patients who cannot attain abstinence or are not (yet) capable of doing so,” said Dr. Karl Mann at Central Institute of Mental Health in Germany, who led the research.

Mann and his colleagues conducted a clinical trial to investigate the effectiveness of nalmefene in reducing alcohol consumption. They recruited 604 alcohol-dependent patients, half of whom were randomized to receive nalmefene, while the other half received visually-identical placebo pills. Neither patients nor their doctors knew which treatment they were receiving. Patients were instructed to take one tablet on each day they perceived a risk of drinking alcohol, and were followed by the study investigators for 24 weeks.

What they found is promising. Nalmefene was significantly better than placebo in reducing alcohol consumption and it improved patients’ clinical status and liver enzymes. It was also generally well-tolerated, with most side effects characterized as mild or moderate and quickly resolved.

Blocking the ‘Buzz’

“With nalmefene, we seem to be able to ‘block the buzz’ which makes people continue to drink larger amounts. With such a harm reduction approach, a new chapter in treating alcoholism could be opened,” said Mann.

These findings provide evidence that “as-needed” prescription of nalmefene is an effective treatment for alcohol dependence. Unlike medications that must be taken every day, the as-needed approach targets medication administration to periods where alcohol use is more likely.

“It is encouraging to see the efficacy of nalmefene in this clinical trial. There is a need for more treatment options for the pharmacotherapy of alcoholism,” said Dr. John Krystal, Editor of Biological Psychiatry. “This study also provides support for ‘as-needed’ treatment, an approach that may be attractive to many patients. However, it flies in the face of the notion that daily treatment may protect people who are either ambivalent about treatment or unaware when they are particularly at risk for relapse.”

Reducing Consumption

The first medication developed for the treatment of alcohol dependence was naltrexone, an opioid receptor blocker. At therapeutic doses, it blocks most of the mu subtype of opioid receptors in the brain but it has lesser effects at the delta and kappa subtype of opioid receptors. Nalmefene is a newer opioid receptor modulator that has a subtly different profile at opioid receptor subtypes, with increased relative potency for kappa opiate receptors compared to its potency at mu opiate receptors. It was studied here because it has been shown to have potential for reducing alcohol consumption.

“It remains to be seen whether the differences between nalmefene and naltrexone at opioid receptors yield meaningful differences in their effectiveness,” cautioned Krystal.

As with most studies, additional research is necessary, but this study provides strong evidence that nalmefene can provide an important clinical benefit for alcohol-dependent patients.

Teenage college students are significantly more likely to abstain from drinking or to drink only minimally when their parents talk to them before they start college, using suggestions in a parent handbook developed by Robert Turrisi, professor of biobehavioral health, Penn State.

“Over 90 percent of teens try alcohol outside the home before they graduate from high school,” said Turrisi. “It is well known that fewer problems develop for every year that heavy drinking is delayed. Our research over the past decade shows that parents can play a powerful role in minimizing their teens’ drinking during college when they talk to their teens about alcohol before they enter college.”

Handbook Helps Parents

The researchers recruited 1,900 study participants by randomly selecting incoming freshmen to a large, public northeastern university. Each of the individuals was identified as belonging to one of four groups: nondrinkers, weekend light drinkers, weekend heavy drinkers and heavy drinkers.

The team mailed Turrisi’s handbook to the parents of the student participants. The 22-page handbook contained information that included an overview of college student drinking, strategies and techniques for communicating effectively, ways to help teens develop assertiveness and resist peer pressure and in-depth information on how alcohol affects the body.

Timing Is Important

The parents were asked to read the handbook and then talk to their teens about the content of the handbook at one of three times to which they were randomly assigned: (1) during the summer before college, (2) during the summer before college and again during the fall semester of the first year of college and (3) during the fall semester of the first year of college.

“We were trying to determine the best timing and dosage for delivering the parent intervention,” Turrisi said. “For timing, we compared pre-college matriculation to after-college matriculation. For dosage, we compared one conversation about alcohol to two conversations about alcohol.”

The results appeared in a recent issue of the Journal of Studies on Alcohol and Drugs.

Drinking Escalates Without Intervention

“We know that without an intervention there is movement from each drinking level into higher drinking levels,” Turrisi said. “For example, non-drinkers tend to become light drinkers, light drinkers will become medium drinkers and medium drinkers will become heavy drinkers. Our results show that if parents follow the recommendations suggested in the handbook and talk to their teens before they enter college, their teens are more likely to remain in the non-drinking or light-drinking groups or to transition out of a heavy-drinking group if they were already heavy drinkers.”

According to Turrisi, talking to teens in the fall of the first year of college may not work as well; for many families it had no effect on students’ drinking behaviors. Likewise, adding extra parent materials in the fall seemed to have no additional benefit.

Religious college students report less alcohol use than their classmates – and the reason may have to do with how their parents handle stress, according to new research by a Michigan State University scholar.

The study found that students who used religious practices such as praying and meditating as a coping mechanism reported less frequent alcohol use and less heavy drinking.

Parents Affect Coping Practices

Further, the parents of those students reported using religious or spiritual practices when facing stress, which was linked to the behaviors reported by the students. This suggests the parents’ behavior had an effect on their children’s coping practices, said Zaje Harrell, MSU assistant professor of psychology.

“Parents face a lot of day-to-day stressors and what they do to cope with these stressors appears to be related to outcomes in their children,” Harrell said. “If you cope with those stressors in a way that is effective, it can show up in your children’s lives in ways you wouldn’t necessarily think.”

Binge drinking on college campuses has become a significant public health concern and previous research has shown a relationship between religious coping and alcohol use, the study says. Harrell is one of the first researchers to look at how parental coping and religious behaviors influence drinking outcomes.

Protective Factor of Religion

Harrell surveyed 129 college students and their parents for the study, which appears online in the Journal of Religion and Health.

Prior to the study, Harrell also predicted the students’ beliefs about alcohol norms and the social support they receive through religion would both protect them against heavy drinking.

Religious students did indeed have more conservative beliefs about when it is appropriate to drink alcohol, and this was a protective factor.

But Harrell was surprised to find that social support, which is often found in religious communities, was not a protective factor against alcohol use.

Physicians often fail to ask high school-aged patients about alcohol use and to advise young people to reduce or stop drinking, according to a study led by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health.

In a random survey of more than 2,500 10th grade students with an average age of 16 years, researchers from NIAAA and the Eunice Kennedy Shriver National Institute of Child Health and Human Development found that 34 percent reported drinking alcohol in the past month. Twenty-six percent said they had binged, defined as five or more drinks per occasion for males, and four or more for females.

Teens Not Asked About Drinking

“While more than 80 percent of 10th graders said they had seen a doctor in the past year, just 54 percent of that group were asked about drinking, and 40 percent were advised about alcohol harms,” says lead author Ralph W. Hingson, Sc.D., M.P.H., director of NIAAA’s division of epidemiology and prevention research.  He adds that, among students who had been seen by a doctor in the past year and who reported drinking in the past month, only 23 percent said they were advised to reduce or stop drinking. The findings are now online in the  February issue of Pediatrics.

The researchers also reported that students who said that they had been asked about their drinking were more likely to be advised about alcohol.  Nevertheless, among the 43 students who said that they were drunk six times or more in the past month and who said they had been asked about their drinking by a doctor, about 30 percent were not advised about drinking risks, and two-thirds were not advised to reduce or stop drinking.

Screening, Intervention Works

The researchers caution that in the survey students were asked about past-month drinking, not what they may have told their physicians about their drinking.

Studies have shown that screening and brief interventions by health care providers – asking patients about alcohol use and advising them to reduce risky drinking –- can promote significant, lasting reductions in drinking levels and alcohol-related problems among adults.  Accumulating evidence supports the use of alcohol screening among adolescents.

Quick Screening Tool

In 2011, NIAAA and the American Academy of Pediatrics released a two-question screening tool designed to help clinicians overcome time constraints and other common barriers to youth alcohol screening.  Examples of these questions, which vary slightly for elementary, middle, and high school ages, include:

“Do you have any friends who drank beer, wine, or any drink containing alcohol in the past year?”

“How about you–in the past year, on how many days have you had more than a few sips of beer, wine, or any drink containing alcohol?”

“Alcohol is by far the drug of choice among youth,” says NIAAA acting director Kenneth R. Warren, Ph.D. “The findings reported by Dr. Hingson and his colleagues indicate that we must redouble our efforts to help clinicians make alcohol screening a routine part of patient care for young people in the United States.”

People who grew up in states where it was legal to drink alcohol before age 21 are more likely to be binge drinkers later in life, according to a study by researchers at Washington University School of Medicine in St. Louis.

The findings are available online in Alcoholism: Clinical & Experimental Research.

The researchers tracked the long-term drinking behavior of more than 39,000 people who began consuming alcohol in the 1970s, when some states had legal drinking ages as low as 18.

More Frequent Binge Drinking

“It wasn’t just that lower minimum drinking ages had a negative impact on people when they were young,” explains first author Andrew D. Plunk, PhD, a post-doctoral research fellow in psychiatry. “Even decades later, the ability to legally purchase alcohol before age 21 was associated with more frequent binge drinking.”

The study shows that people who lived in states with lower minimum drinking ages weren’t more likely to consume more alcohol overall or to drink more frequently than those from states where the drinking age was 21, but when they did drink, they were more likely to drink heavily.

The effect was most pronounced among men who did not attend college. And the researchers say the findings should be a warning to those who advocate lowering the minimum drinking age.

Non-College Drinkers Affected Too

“Binge drinking on college campuses is a very serious problem,” Plunk says. “But it’s also important not to completely forget about young people who aren’t on college campuses. In our study, they had the greatest risk of suffering the long-term consequences linked to lower drinking ages.

Plunk and his colleagues found that even decades later, men who grew up in states with a legal drinking age lower than 21 were 19 percent more likely to binge drink more than once per month. Among those who didn’t go to college, the odds of binging more than once a month increased by 31 percent.

Through surveys conducted in the early 1990s and again in the early 2000s, the researchers tracked the average daily alcohol intake, overall drinking frequency and the frequency of binge episodes — defined as five or more drinks during a single period of drinking for a man or four-plus drinks for a woman. They also looked at how often a person drank but did not binge, which is thought to be a less harmful drinking pattern.

Detecting Harmful Drinking Patterns

“There’s a difference between tracking average daily consumption of alcohol and measuring drinking patterns,” explains senior author Richard A. Grucza, PhD, an associate professor of psychiatry. “Merely tracking average daily consumption can hide harmful drinking patterns. Averaging one drink per day doesn’t sound like much, but if that same person has all their drinks for the week in one sitting, well that’s a potential problem.”

Due to concerns about binge drinking on college campuses, some policymakers think that lowering the drinking age may encourage college students to moderate their alcohol use.

“The ‘take away message’ is that we need to consider all of the potential consequences of changing the drinking age,” Plunk explains. “We shouldn’t be too narrow in our focus when we think about how young people are affected by these laws. This study shows there’s a large population that benefitted from a higher legal drinking age. Laws apply to everyone, but if they are based only on the impact on one group like college students, we may end up forgetting about how those laws affect other people.”

A relatively small number of alcohol brands dominate underage youth alcohol consumption, according to a new report from researchers at the Boston University School of Public Health and the Center on Alcohol Marketing and Youth (CAMY) at the Johns Hopkins Bloomberg School of Public Health. The report, published online by Alcoholism: Clinical & Experimental Research, is the first national study to identify the alcohol brands consumed by underage youth, and has important implications for alcohol research and policy.

The top 25 brands accounted for nearly half of youth alcohol consumption. In contrast, adult consumption is nearly twice as widely spread among different brands. Close to 30 percent (27.9%) of underage youth sampled reported drinking Bud Light within the past month; 17 percent had consumed Smirnoff malt beverages within the previous month, and about 15 percent (14.6%) reported drinking Budweiser in the 30-day period:

Rank, Brand Reported Use in Previous 30 Days Among Underage Youth

1. Bud Light 27.9%

2. Smirnoff Malt Beverages 17.0%

3. Budweiser 14.6%

4. Smirnoff Vodkas 12.7%

5. Coors Light 12.7%

6. Jack Daniel’s Bourbons 11.4%

7. Corona Extra 11.3%

8. Mike’s 10.8%

9. Captain Morgan Rums 10.4%

10. Absolut Vodkas 10.1%

Of the top 25 consumed brands, 12 were spirits brands (including four vodkas), nine were beers, and four were flavored alcohol beverages.

Profiting From Youth Drinking

“For the first time, we know what brands of alcoholic beverages underage youth in the U.S. are drinking,” said study author David Jernigan, PhD, CAMY director. “Importantly, this report paves the way for subsequent studies to explore the association between exposure to alcohol advertising and marketing efforts and drinking behavior in young people.”

Alcohol is responsible for 4,700 deaths per year among young people under the age of 21. More than 70 percent of high school students have consumed alcohol, and about 22 percent engage in heavy episodic drinking. At least 14 studies have found that the more young people are exposed to alcohol advertising and marketing, the more likely they are to drink, or if they are already drinking, to drink more.

Reducing the Appeal

The researchers surveyed 1,032 youth ages 13-20 via an Internet-based survey instrument. Respondents were asked about their past 30-day consumption of 898 brands of alcohol among 16 alcoholic beverage types, including the frequency and amount of each brand consumed in the past 30 days.

“We now know, for the first time, what alcohol brands – and which companies – are profiting the most from the sale of their products to underage drinkers,” said lead study author Michael Siegel, MD, MPH, professor of Community Health Sciences at the Boston University School of Public Health. “The companies implicated by this study as the leading culprits in the problem of underage drinking need to take immediate action to reduce the appeal of their products to youth.”

Researchers from the Boston University School of Medicine (BUSM) and Boston University School of Public Health (BUSPH) have shown that alcohol is a major contributor to cancer deaths and years of potential life lost. These findings, published in the April 2013 issue of the American Journal of Public Health, also show that reducing alcohol consumption is an important cancer prevention strategy as alcohol is a known carcinogen even when consumed in small quantities.

Previous studies consistently have shown that alcohol consumption is a significant risk factor for cancers of the mouth, throat, esophagus and liver. More recent research has shown that alcohol also increases the risk of cancers of the colon, rectum and female breast. While estimates have shown that alcohol accounts for about four percent of all cancer-related deaths worldwide, there is a lack of literature focusing on cancer-related deaths in the U.S.

20,000 Deaths Per Year

Timothy Naimi, MD, MPH, from the Department of Medicine at BUSM and colleagues from the National Cancer Institute, the Alcohol Research Group, Public Health Institute and the Centre for Addiction and Mental Health, examined recent data from the U.S. on alcohol consumption and cancer mortality. They found that alcohol resulted in approximately 20,000 cancer deaths annually, accounting for about 3.5 percent of all cancer deaths in the U.S.

Breast cancer was the most common cause of alcohol-attributable cancer deaths in women, accounting for approximately 6,000 deaths annually, or about 15 percent of all breast cancer deaths. Cancers of the mouth, throat and esophagus were common causes of alcohol-attributable cancer mortality in men, resulting in a total of about 6,000 annual deaths.

18 Years of Life Lost

The researchers also found that each alcohol-related cancer death accounted for an average of 18 years of potential life lost. In addition, although higher levels of alcohol consumption led to a higher cancer risk, average consumption of 1.5 drinks per day or less accounted for 30 percent of all alcohol-attributable cancer deaths.

“The relationship between alcohol and cancer is strong, but is not widely appreciated by the public and remains underemphasized even by physicians,” said Naimi, who served as the paper’s senior author. “Alcohol is a big preventable cancer risk factor that has been hiding in plain sight.”